2015-2016

Personal Information Page

To be completed by Juniors and Intermediates

Name ______Email ______

(First)(Middle)(Last)

Home Address ______City ______

Zip ______Home Phone ______County ______

Date of Birth ______Current 4-H Age (as of Sept 1) ______

Number of Years in 4-H (excluding Clover Kids) ______Number of Years in Main Project ______

Place of Residence (mark one)Race/Ethnicity (mark all that apply)

_____Farm/Ranch_____White

_____Rural area or town less than 10,000_____African American

_____Town or city of 10,000 to 50,000_____Native American

_____Suburb or city more than 50,000_____Hispanic

_____Central city of more than 50,000_____Asian

_____Other

Recordbook Category ______

Name of Your 4-H Club or Group ______

Number of Members in Your Club or Group ______

Signature of 4-H Member: ______Date: ______

Signature of Parent: ______Date: ______

Signature of CEA: ______Date: ______

2015-2016

Junior / Intermediate Report Form

SECTION I –4-H PROJECT EXPERIENCES
4-H Project Summary and Learning Experiences – What is your project? How did your project change or grow? What have you done and what have you learned? (Limited to 3 pages)
Food and Nutrition / 2015-2016
Project Meetings Attended / 5
Competitions (Food Shows, Fairs, Nutrition Quiz Bowl) / 4
Food Show Expenses / $36
People Taught / 12
Number of Times Helped with Family Meals / 24
Project Name / 2015-2016
Project Name / 2015-2016
Project Name / 2015-2016

2012-2L13

VETERINARY SCIENCE
Year / Level / What I Did / What I Learned
15-16 / L-2 / T-Pampa Vet / Vet science project could lead to a job as a vet tech or a veterinarian.
FOOD AND NUTRITION
Year / Level / What I Did / What I Learned
15-16 / L / W- Bread / Learned how to make bread in a bag.
CLOTHING
Year / Level / What I Did / What I Learned
15-16 / C / T- Westgate Mall / Garment construction, price, and fit are three important considerations before making a clothing purchase.
HORSE
Year / Level / What I Did / What I Learned
15-16
SECTION II – 4-H LEADERSHIP EXPERIENCES
List what you did to assist others throughout this 4-H year. Also include general leadership such as Club Officer, 4-H County Council, or County Committees on your main project record. Include elected/appointed and volunteer leadership.
(Limited 2 pages)
Activity Date / Leadership Activity / Leadership Role (Elected, Appointed, Volunteer, Promotional) / Level (Club, County, District, State, National, International) / Responsibilities / Duties / Accomplishments / Number of People Reached/Taught Served / Hours
10/15 / Invited guest speaker to 4-H meeting. / Volunteer / Club / Asked guest to speak on opportunities to serve at the Ronald McDonald house. / 25 / 1.5
SECTION III – 4-H COMMUNITY SERVICE
List community service or service learning projects that might include: clean ups, collections, repairs, construction, care packets, visitations, education, donations, and presentations. (Limited 2 pages)
Activity Date / Your Role (Yourself, Member of a Group, or Primary Leadership / Service Activity / Importance and Impact / Hours
11/7/15 / M / Honor Our Troops / Learned importance of giving back to those serving our country. / 1
SECTION IV – OTHER 4-H PROJECTS
List other project(s) not listed in Section I, include number of years and summarize participation. (Reminder: limited to 1 page)

(No points deducted if this section is not filled out by juniors or intermediates.)

SECTION V – 4-H RECOGNITION AND AWARDS
List 4-H recognition and awards. (Reminder: Limited to 1 page)
Activity Date / Level (Club, County, District, State, National, International) / Recognition / Importance to You
9/21/2015 / County / Bronze Star / Excited to be recognized for my hard work in my 4-H club, learned hard work pays off.
SECTION VI – NON 4-H ACTIVITIES
List leadership, community service, awards and recognition from other activities such as school, church, and other community organizations. (Reminder: Limited to 1 page)