4-H Ontario Longstanding Graduate Gift Reimbursement Form

4-H Ontario Longstanding Graduate Gift Reimbursement Form

Sponsored by Kubota Canada
Through the generous sponsorship of Kubota Canada, 4-H Ontario is pleased to offer the Longstanding Graduate Award to all Graduating 4-H Members who are graduating this year and who have completed 4-H projects in at least 5 of the last 7 years (including 2025).

4-H Associations are asked to purchase a gift that is specifically meaningful to each graduate. Reimbursement is available at a maximum of $75 per graduate. 4-H Associations are welcome to spend more than $75 on the gift if they so choose, at their own expense.

Please complete and submit this form and all receipts at least 4 weeks prior to your Awards Celebration. Forward any questions to Kelly at database@4-hontario.ca.

Receipt Submission
Please submit receipts for all related expenditures (to a maximum of $75/graduate) below.
Please upload a photo of all related receipts here.*

Please attach as a PDF file if possible
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Gift Reimbursement
Number of Longstanding Graduates Being Awarded
Total Reimbursement Requested ($)
(Maximum $75 per Longstanding Graduate– any costs incurred above this amount will not be reimbursed)
Our Association is able to receive reimbursement by e-transfer.

No, I do not use e-transferringYes (please specify email address)

Award Presentation Details
Please give a brief description of your Association’s plans forpresenting the award(s)/gift(s).
I,Name agree to the following statements:
- I have reviewed the Longstanding Graduating Member Award Instructions and Details and agree to acknowledge Kubota Canada Ltd in the ways outlined in appreciation for this award (see email to be sent following form submission).
- By signing below, I have agreed to adhere to all of the details above.
Date

MonthDayYear
Date
Signature

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Thank you for taking the time to ensure that your Longstanding Graduates are properly acknowledged!

4-H Ontario respects the privacy of its members, volunteers, donors, sponsors, staff and stakeholders. We are committed to ensuring that appropriate measures and safeguards are in place to protect specific information that is held for the purpose of 4-H Ontario programs. We adhere to legislative requirements with respect to privacy. We do not rent, sell or trade mailing lists. If at any time you wish to be removed from any of our contact lists, simply contact us by phone at 519-856-0992, toll free at 1-877-410-6748, by fax at 519-856-0515 or via our website at www.4-H Ontario.ca. We will gladly accommodate your request. For further information regarding our commitment to privacy, please contact 4-H Ontario’s Privacy Officer at privacy@4-hontario.ca.
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Reimbursement Form