Leader Checklist: 4-H Member Completion Pin & Award Form 2016
Note to Leaders:
In order for your 4-H’ers to qualify for their year pins, we need you to fill out this check-list completely (one for each 4-H’er) AND submit the form and results on your 4-H Club Completion Form.
4-H’er Name ______Club______
Year Pin
This 4-H’er did/did not (please circle one) qualify for a year pin. Indicate which year ____
q Attended 66% (2/3) of club meetings
q Kept a 4-H Record Book
q Did a Public Presentation (or taught a class – prior approval by Leaders’ Council req’d - for seniors only)
q And did at least two of the following:
o Exhibited project(s) at fair or other show (indicate what project and which show)______
o Served on a committee or held an office (indicate office and/or committee)______
o Did a community service project (indicate purpose of project) ______
o Completed a leadership project (indicate completion date) ______
o Attended a 4-H educational activity, such as 4-H Camp, State 4-H Conference, Super Saturday, Know Your Government, etc. (indicate which events were attended) ______
Patch Award
This 4-H’er did/did not (please circle one) earn a Patch Award. If they did, please indicate if it is their first, or which number they should receive. If they did not, please go no further in this section. Each person must qualify in all of the boxes if checked. Indicate which year_____
q Displayed excellent Sportsmanship throughout the year
q Attended ¾ of major 4-H Events (Super Saturday, Spring Show, Achievement, or Rally Night)
q Did a Public Presentation (or taught a class – prior approval by Leaders’ Council req’d --seniors only)
q Participated in program fund raising and club fundraising
q Did a Community Service Project (indicate activity) ______
q Exhibited project(s) at Whidbey Island Area Fair (indicate project) ______
q Submitted an Educational Display and/or Poster ______
q Held a club office and a committee job (indicate office/committee) ______
q Scored 95 and above on their Record Book (Leaders Skip this portion. It will be completed at the office
q Attended 85% of Club Meetings
q Demonstrated leadership and community involvement
Over
County Gold Medals
This 4-H’er should be considered for a gold medal in ______(project, example: horse, dog, poultry, etc.). I certify that they:
q Qualify for a year pin (if not qualified for a year pin, go no further in this section)
q Have been active in the project and with the club for a minimum of 6 months during the past 4-H Year)
q Have my recommendation as described below:
4-H’er’s name ______should be considered for a gold medal because of the following ways in which they have improved over last year’s achievements, or have excelled in their projects (please be sure to alert us to any special challenges this 4-H’er might have):
______
______
To qualify for a Gold Medal, youth need to have also received a blue placing for their record book. This will be checked by the office.
Leader’s Name Signature Date
Club
** Special note to leaders. Reviewing the year of each member, looking at record books, and making recommendations for awards is very time consuming. We appreciate all of the energy that you put into the process. We value your thoughtful and sincere recommendations.