Holiday Lake Forestry Camp
2012 Nomination Form

June 18-23, 2012
Holiday Lake 4-H Educational Center
Appomattox-Buckingham State Forest

Holiday Lake Forestry Camp is an academic, structured, residential camp that focuses on field experiences in forestry and other natural resources.

Nominees:

1. are boys and girls ages 13 to 16;
2. are Virginia residents;
3. show an interest in natural resources, and
4. have not attended before.

A nominator must be a non-related adult who knows the student well. Nominators should print and share the information sheet and discuss the camp with students before making nominations. Nomination does not guarantee acceptance. Nominees will be asked to complete a short questionnaire before being considered.

Nomination Form

All information must be complete. Nomination deadline: April 16, 2011.

Student (Nominee) Information

Nominee items:	Nominee Information:
First Name:	A value is required.
Middle Initial:	A value is required.
Last Name:	A value is required.
Date of birth:	A value is required.
Grade:	A value is required.
School:	A value is required.
Student Address:
City:
State:
Zip Code:
Home Phone:	A value is required.
Student Email:

Parent/Guardian Contact Information

Parent/Guardian items:	Parent/Guardian Information:
First Name:	A value is required.
Last Name:	A value is required.
Parent Phone Number:	A value is required.
Parent Email:

Abilities

Ability	Poor Rating	Fair Rating	Good Rating	Excellent Rating
Attitude:	Poor	Fair	Good	Excellent
Scholastic Standing:	Poor	Fair	Good	Excellent
Interest in Natural Resources:	Poor	Fair	Good	Excellent
Ability to work with others:	Poor	Fair	Good	Excellent

Activities

4-H FFA Scouting Envirothon Ecology/Biology Club
Other Outdoor/Nature-Related Activities:

Reasons for Nomination:

Nominated By

Nominator items:	Nominator Information:
First Name:	A value is required.
Last Name:	A value is required.
Title:
School or Affiliation:	A value is required.
Phone Number:	A value is required.
Mailing Address:
City:
State:
Zip Code:
Email:

Last modified: Wednesday, 08-Feb-2012 10:46:58 EST