S P O N S O R E D   B Y

Kiwanis Club of Forest City
Western Fair Association

In co-operation with 4-H Associations in the counties of:
Elgin - Essex - Huron - Kent - Lambton - Middlesex - Oxford - Perth

Our Mission
"The Western Fair Association is an Agricultural Society that, through its people
and activities, excels in creating unique experiences that fulfill the evolving entertainment
and educational interests of our customers."

Please complete the following information and submit it by clicking on the 'Submit'
button located at the end of this form. Applications must be received by Friday July 28, 2000.
Interview date is set for Saturday August 19, 2000 at the Western Fair Grounds, London.

Member's Name:




Date of Birth:


Postal Code:

E-Mail Address:

 Address if attending College/University


Postal Code:




Section A - 30 Points - 4-H Projects & Activities
Number of years enrolled in 4-H program:
List the 4-H projects you have completed:

List the Offices you have held in 4-H:

List special county, regional, provincial and national activities in which you have
participated or received awards:

Section A Continued - Further Information
Tell us what qualities and contributions you can personally give to carrying the
"4-H Achiever of the Year" title?

How will this bursary help you to attain your future goals?

Section B - 15 Points - Community Involvement & Extra Curricular Activities
School (clubs, sports, etc.):

Community (Church, Jr. Farmers', etc.):

Interests and Hobbies:

Responsibilities at Home:

Section B Continued - Education
Present Grade: Where:
Scholastic Achievements & Previous 2 Years Average:

Future Plans (education, employment) - Beyond Summer of 2000:

Section C - 15 Points - Essay/Letter
Share your views in the form of a typewritten letter to the President of the Western
Fair Association. (Approximately 500 words).

With a decline in family farming, how can Western Fair promote
agriculture to the urban community?

Before submitting your application, please check to make sure all portions are
completed. If necessary, please indicate by clicking on the box below, whether you
have received parental (guardian) permission as well as providing their name and a
phone number where they can be reached for confirmation.

Yes, I have parental (guardian) permission

Parent/Guardian's Name: