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Bond-Clinton-Jefferson-Marion-Washington Unit

4-H Member Record

This record is a summary of all of the things you have done while in 4-H. Read all instructions at the beginning of each section carefully. One line or column is provided for each year. This record can be used in evaluating your progress and planning future work. It will also be the basis for award selection.

Name Birthdate

Mo. Da. Yr.

Address

Street Town and Zip

Telephone Year I Joined 4-H

Club/Group

*Please note that a member my only receive points on each item one time. Repeat responses under various categories will not be scored more than once.

* This application will also be scored on the 4-H members’ ability to communicate their ideas effectively, organization, neatness, spelling and punctuation.

* The 4-H Name and Emblem are Protected Under 18 U.S.C. 707.

University of Illinois Extension at Urbana-Champaign provides equal opportunity in employment and programs

for all persons, and prohibits discrimination because of race, religion, color, age, handicap, sex or national origin.

State · County · Local Groups · USDA Cooperation

I. Participation in Local 4-H Club or Group

Begin with your first year in 4-H and list meetings held, meeting you attended, offices held and committee participation in your local club or group.

** Committees must have planned meetings to complete the job assigned to them. If there are activities that you helped with, but did not serve on the committee, list these activities in the Participation section on page 8.

Number of meetings

Year / Held
after
joining / Attended
after
joining / Club officers, Junior leader or Federation representative / Committees worked on, and assistance to club leaders
(indicate a committee
chaired with a capital "CH")
20
20
20
20
20
20
20
20
20
20
20

Total

/ (Put totals in pencil)

II. Promotional Appearances in Support of 4-H or U of I Extension

Presentation to non-4-H groups or appearances on radio or television related to the 4-H program.

Indicate topic presented and audience reached. Include any recognition for the groups special projects.

Ex: Promotional booth at festival.

Year Appearance, Event or Program / Audience / Live / Radio / TV
20
20
20
20
20
20
20
20
20
20
20

III. 4-H Leadership in County, Multi-County, Regional, or State 4-H Programs

Indicate committees worked on and major responsibilities. Also include teaching experiences. Mark County (C), Multi-county (M), Regional (R), State (S) with appropriate letter. Begin using this section as you become involved in 4-H beyond club level. Club leadership is recorded on page 2.

Year

20
20
20
20
20
20
20
20
20
20
20

IV. Community Activities

Summarize what you have done in your school, community, and church activities (EX: band, FFA, choir, church, Scouts, civic group).

Participation in school, community
or church groups / Offices held and committees chaired / Honors & Recognitions and Date
Example:
2001 School-Band / Band President
Fund Raiser - CH / Outstanding Musician
20
20
20
20
20
20
20
20
20
20
20

V. 4-H Projects - Enrollment and Exhibits

Begin with your first year in 4-H and list your projects by curriculum area. Use one row (across) for each year and one column (down) for each curriculum area. List the project name in the appropriate column. Indicate the project unit, total size of your project, what you exhibited, and all other work done including articles, animals, recipes, etc. (Refer to the 4-H Clover for a list of curriculum areas and project units.) Total the project column in pencil. List county exhibit ratings (A,B,C) in column C and judges’ delegate or alternate exhibit selections (Del or Alt) in Del/Alt column. Additional inserts of this page are available from your 4-H leader.

Animal Science and
Plants & Soils / Exhibit / Community Involvement & Global Awareness / Exhibit / Environment & Natural Resources / Exhibit

Year

/ C / DelAlt / C / Del Alt / C / Del Alt
20
20
20
20
20
20
20
20
20
20
20

Total

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Example / Agriculture / Exhibit / Food & Nutrition / Exhibit / Personal Development / Exhibit
Year / C / Del Alt / C / Del Alt / C / Del Alt
2000 / Beef I
1 steer
1 heifer
corn 5 acres / A
A
A / You Learn to Bake (12 recipes)
Microwaving (8 recipes) / A
B / Del / Visual Arts 4 areas / A
A
A
B / Alt
Food, Nutrition
& Health / Exhibit / Home & Family / Exhibit / Engineering & Technology / Exhibit / Personal Development
& Achievement / Exhibit
Year / C / Del Alt / C / Del Alt / C / Del Alt / C / Del Alt
20
20
20
20
20
20
20
20
20
20
20

Total

Have you totaled each column in pencil?

VI. Honors and Recognition Received in 4-H

Over and above A,B and C project ribbons, and State Fair delegate and alternate selections.

Include medals, certificates, trophies, etc. from Achievement night; grand champions, showmanship, etc.

from 4-H shows and individual awards from 4-H activities and programs.

Year / Project / Medals / Certificates / Trophies and Plaques / Other 4-H Awards
20
20
20
20
20
20
20
20
20
20
20

VII. Participation in 4-H Programs

For each year, record the month you participated in each of the programs. The column "where done" refers to where you participated in the program. "Club" refers to what you did on your own or in a program that several or all of your 4-H group participated in. "County" refers to 4-H programs offered on the county level. "Multi-county" refers to 4-H programs offered for two or more counties. “State” refers to those programs offered at state level.

Please include a written summary of these activities. These summaries can be in narrative or outline form.

Example: Community Service – June – Collected Canned Goods for the County Food Pantry

Program / Where Done / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20
Achievement Program / Club
County
Agriculture
/ Club
County
Camping / County
County
4-H Camp / Multi-County
Career Exploration / Club
County
Citizenship (Ex.: CWF, Legislative Ambassador,
Legislative Connection) / Club
State
National
Clothing (Fashion) Revue / County
State
Community Service / Club
County
State
Educational Tour
/ Club
County
Energy Conservation
/ Club
County
Fundraisers / Club
County
Illini Summer Academies / State
4-H Day with the ______
Sporting Team / Multi-County
Regional
State
4-H Junior Leadership Conference / State
4-H Federation Meetings (List
No. of meetings attended) / County
4-H Scarecrow Contest
4-H Holiday Tree Contest / County
Handbook Cover Contest / County
Health / Club
County
Judging Contest (you are the judge ex: livestock or state / Club
judging contests) / County
Regional
State
Program / Where Done / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20
Illinois State Fair Exhibition / Award of Excellence
Superior Rating
International / Club
County
State
Livestock Auction / County
Livestock Rate of Gain / County
Officers Training / Club
County
Poster Contest
Window Display / County
Premiere Carcass / County
State
Public Speaking / Club
County
State
Recreation (Ex.: Lock-In, skating, bowling, softball, etc.) / Club
County
Multi-County
Safety / Club
County

List other programs and workshops sponsored by 4-H or Extension not listed above.

Program / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20

Standards of Excellence Check-List

Standards to be reached to be an Achievement Member:
Ages 8 to 11 complete 1 through 4* Ages 12 to 14 complete 1 through 7* Ages 15 to 18 complete 1 through 10*
20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20 / 20
1. Select a project, decide what to do in
project, complete record.

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2. Attend at least 2/3 of club meetings after
enrolling (or number determined by club
or club leader).

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3. Give a talk or demonstration or
presentation at club level.
4. Exhibit a project at the 4-H show.
5. Serve on a club committee or hold a
club office.

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6. Participate in a community service activity
or in a learning activity in the community.

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7. Assist leaders with a special club activity,
tour or program.

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8. Participate in a 4-H learning experience at
the county, multi-county, regional or state
level.

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9. Provide leadership for a project, an activity or for a 4-H group.
10. Assist in conducting programs at the
county level or beyond.

* Note: 4-H’ers MUST BE Achievement Members (Standards of Excellence Check-List)

according to age group to qualify for awards.

We have reviewed this record:

Year
/ Member’s Signature / Parent’s Signature / Leader’s Signature
20
20
20
20
20
20
20
20
20
20
20