WSU Extension > San Juan County WSU Extension > 4-H Program > 4-H Leaders’ Council > Educational Activity Support Application

Educational Activity Support Application

Educational Activity Scholarship Activity Follow-Up Questionnaire

San Juan County 4-H Leaders' Council Educational Activity Support (EAS) Application

Current EAS Committee Members:
Terri Brown, San Juan Island
Jan Sanburg, Shaw Island
Kathy Morris, Orcas Island

"*" indicates required fields

My enrollment status is:*

Youth Member

Adult Volunteer

SJC Chaperone

Name*

First Last

Phone*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

My Physical Address is Different than my Mailing Address

Yes

Physical Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Email*

Event Name*

Event Date*

Reimbursement Request Amount - Please upload all receipts*

Enter Dollar Amount

Checks will be made payable to the applicant; this enables the Leaders' Council Treasurer to document recipients.

Please let us know if you require either of the following:

Please check if you will need funds prior to the event and would not be able to attend if assistance would not be available to you prior to departure or registration deadline. If for some reason I cannot attend, I will notify the Extension Office of my plan immediately.

Hardships: Please check if you will need additional funds beyond what is being offered in order to attend an event or activity. You will be contacted to find out what additional support you will need.

Receipts

Drop files here or

Max. file size: 80 MB.

Please upload pictures or scans of any receipts.

Questions? Contact Clinton Gauthier at WSU Extension: 360-370-7662 or sanjuan.4-h@wsu.edu or any EAS Committee member.

Extension programs and policies are consistent with federal and state laws and regulation on non-discrimination regarding race, color, gender, national origin, religion, age, disability and sexual orientation. Evidence of noncompliance may be reported through your local Extension office.