4-H Request for Variance Form
Print the 4-H Request for Variance Form
Teton County 4-H Request for Variance Form
Name:__________________________________________________________________ Age:________________________
Mailing Address:_____________________________________________________________________________________
Explain the rule and/or deadline that was not met:
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
What is the reason the rule and/or deadline was not met?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
What action are you requesting to be taken or what variance are you requesting? Why?
_______________________________________________________________________________________________________
_______________________________________________________________________________________________________
________________________________________________________________________________________________________
What consequence would you consider?
___Late fee and/or suggested amount:________________________________________________________________
___Service (to Extension, 4-H community, etc):_________________________________________________________
___Leadership Project:_________________________________________________________________________________
___Other:_______________________________________________________________________________________________
Signature:_____________________________________________________Date:____________________________________
Parent/Guardian Signature:___________________________________Date:____________________________________