Missouri 4-H

Recognition Form

(MRF)

(Age 14-18)

Cape Girardeau County Project Medals


Name of project or activity reported in Section I of this form ______

Name ______Boy _____ Girl _____

First Middle Last

Home address ______

Street City State Zip

Home telephone number ( ) ______Age as of January 1 this year ______

Birth date ______Social Security Number ______

Name of your 4-H Club or group ______Number of members ______

Name of school ______Grade ______

Statement by 4-H Member

I have personally prepared this report and believe it to be correct:

Date ______20______Signature of 4-H Member ______

Approval of This Report

We have reviewed this report and believe it to be correct:

Date ______20______Signed ______

Parent or Guardian

Date ______20______Signed ______

Project 4-H Leader Signature

Instructions: List by years, with the most recent year last. Show level of participation as (L) local or club, (C) county, (A) area, and (S) state.

Section I – Experiences In ______Project or Activity

A: Size and Scope
Articles Made or Animals Raised / Cost of Materials / Value of Articles/Animals / Profit
or Loss

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B: Awards and Recognition
Year / Type of Award / For What Reason / Level/
Number
C: Learning Experiences
Title of talks or demonstrations / Number and title of radio or TV appearances, new articles written / Kind of tours, field trips, workshops, or camps attended / Number and type of exhibits, judging events

D: Knowledge and Skills – Summarize and tell how you are using the most important knowledge and skills you have acquired in this project/activity.

______

______

______

______

______

______

______

______

______

This section should include 4-H Project information not included in Section I.
Section II – Leadership Experiences

A: List your leadership experiences in judging; helping others plan programs; lead discussions; prepare demonstrations, talks, exhibits; participate in judging. Put an (*) by those experiences which relate to your main project in section one. List activities by years.

______

______

______

______

______

______

______

______

B: Elected/Appointed Leadership – List 4-H offices you have held and committees you have served on, what was done, and your responsibilities.

Office or Committee / What was done / Your responsibilities

Section III – Citizenship/Community Service

A: List your citizenship or community service jobs that helped your club or community. Put an (*) by those things that relate to your main project.

Year / Kind of Activity and Level / Size an Scope of What You Did / Your Responsibilities

B: Non 4-H Experiences in School, Church, and Community – List your participation in school, church, and community organizations other than 4-H; include participation, leadership roles and honors received. List only your most meaningful experiences.

School / Church / Community

Section IV – Experiences in Other 4-H Projects and Activities: Only report on projects and activities not reported in Section I.

A: Size and Scope - List things you did or made in other projects or activities.

Year(s) / Project or Activity / What I Did
B: List significant awards
Year(s) / Type of Award / For What Received / Project Area / Level/
Number

C: List what you did or accomplished in other projects or activities not reported in section 1:

Project or Activity / Demonstrations, talks, radio &TV shows, news articles written / Tours, field trips, workshops, camps, judging events / Exhibits and awards

D. Knowledge and Skills – Summarize and tell how you are using the most important knowledge and skills you have acquired in other 4-H projects and activities.

Project or Activity / Knowledge and Skills Gained

Section V – Your 4-H Story (Limit to 3 pages, one side only. You may use notebook paper.)

1.  Write a paragraph telling who you are and why you joined 4-H.

2.  Write a paragraph telling why you chose the project reported in Section I. Write another paragraph telling about your interesting experiences in this project.

3.  Write a paragraph about your experiences in other projects and activities reported in Sections II, III, and IV.

4.  Write a paragraph about what things you like best about being a 4-H member.

Section VI – Photographs

Instructions: Place color or black & white pictures, which show things you have done or made in the project or activity, listed in Section I. Write a short sentence beneath each picture to explain what is happening in the picture. Limited to three pages on one side only. May be mounted on any kind of paper.

/ Issued in furtherance of Cooperative Extension Work Acts of May 8 and June 30, 1915, in cooperation with the United States Department of Agriculture. Ronald J. Turner, Director, Cooperative Extension, University of Missouri and Lincoln University, Columbia, MO 65211. · University Extension does not discriminate on the basis of race, color, national origin, sex, religion, age, disability or status as a Vietnam era veteran in employment programs. · If you have special needs as addressed by the Americans with Disabilities Act and need this publication in an alternative format, write ADA officer, Extension and Agricultural Information, 1-98 Agricultural Building, Columbia, MO 65211, or call (573) 882-8237. Reasonable efforts will be made to accommodate your special needs.

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