National Grange Youth Officers Team
Age as of Jan. 1
Prefer not to disclose, Please contact Charlene Espenshade
Subordinate Grange name and number
1st Choice for State office
2nd Choice for State office
3rd Choice for State Office
Which Achievement awards (3 or more) have you earned? Must be earned between Aug. 31 2016 and Sept. 1, 2017. (one must be John Thompson and Grange Trivia does not count)
What factors would prevent you from coming to the National convention other than illness or death?
If a student, have you obtained permission from teachers/ professors?
How are you going to pay for the trip?
Give 5 to 8 lines description about yourself and/or family to be used for display purposes throughout the National Session. Please upload three photos including one picture of you and your family. These pictures will be displayed at National convention along with a short bio throughout Annual Session.
Grange Experience: List Leadership roles you have fulfilled in Grange indicating service on committees, boards or as officers for your subordinate/ community Grange, include years.
Grange Experience: List Leadership roles you have fulfilled in Grange indicating service on committees, boards or as officers for your state/national Grange, include years.
Leadership Experience: List community and service programs you have participated in include the name of the organization as well as leadership roles within these programs. (Programs include civic and service clubs, professional organizations, church, school, volunteer leadership, etc.)
List significant offices held or awards achieved while participating in youth organizations.
What additional awards and recognition have you received in the past?
What are your leadership goals for the next five years?
What have you done to promote membership in the Grange? How many people have you encouraged to join Grange. how many actually joined?
Your Digital Signature
Parents Digital Signature (if under 18)
Subordinate Certification: This will certify that the above name is an active member in good standing of your Grange, and is eligible to participate in this program, and the the information contained in this report is correct. Subordinate Youth Chairman or Secretary Signature
Master's (president's) Signature
State Certification: Youth Directors Signature
State Certification: State Master's (president's) Signature
Attach Letters of Recommendation below
You may need to give your login information to the officer writing your letter of recommendation so they can attach it.
Subordinate Grange, preferably Master or Secretary
State Youth Director
Should be Empty: