Carroll County Individual 4-H Honor Member Application Form

Transcription

1 Carroll County Individual 4-H Honor Member Application Form Due in the Extension office no later than the last Monday in August. All requirements must be completed during the current 4-H Program year (September thru August). 11/02/2013 Name Number of years in 4-H (Include Cloverbud years) 4-H Club Circle year applying: 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th (A 4-H'er can apply for Honor member once they are in 3rd grade.) Requirements: Items 1-7 MUST be completed by every member, plus additonal points to total: 1st yr nd rd th th th th th th th/11th Important: ALL 5th - 11th year honor member applicants must also complete a county award form. PERSONAL ACHIEVEMENT 1.) I can recite the 4-H Pledge and Motto ) I've had no more than 1 unexcused absence from a regularly scheduled meeting ) Give a demonstration at a club meeting. Title: Date: 10 4.) Give at least one health/safety talk at a club meeting. Title: Date: 10 5.) Complete at least one project area. (5 points per judging) A. Livestock Judging 5 B. Creative Arts Judging 5 C. Clothing Judging 5 D. Foods & Nutrition Judging 5 E. Still Project Judging 5 F. Creative Writing 5 6.) I participated in at least one community service project. Project 1 Date: 10 Project 2 Date: 5 Project 3 Date: 5 7.) Attend or participate in at least one county-wide activity. (5 points each) a. Kick-off night j. Carcass contest b. Officer training k. C.C. PAS show/ Horse fun show c. 4-H camp l. Exhibited Livestock at the fair d. Fair Clean up (prior to fair) m. Exhibited Still project at the fair e. Best of 4-H Night n. Participated in fair f. Livestock Jamboree o. Helped build the fair fair g. Benefit Auction p. Project Clinic (Name & Date below) h. Quality Assurance Total pts #7 i. Still Project Quality Assurance Total Page 1

2 PERSONAL LEADERSHIP OPPORTUNITIES - Must be during current 4-H year 8.) Served as an officer in my club(s). Club Office 10 Club Office 10 9.) Served as a committee chair. Committee: ) Provided leadership to another 4-H member. Who: ) Participated in club fundraiser. Describe: ) Completed a project I've never tried before ) Completed at least 4 projects during the current 4-H year ) Recruit 1 new member. Name: ) Recruit 1 new advisor. Name: ) Serve on the Junior Fairboard ) Serve as a camp counselor or CIT ) Be an active member of the Teen Leaders Club ) Give a demonstration before 10 or more people other than your 4-H club ) Give a presentation about 4-H to another organization. Name: Date: ) Participate in an activity during 4-H week. 22.) Complete the interview process for Outstanding Court ) Complete the interview process for Fair King/Queen ) Complete the interview process for Cowboy/Cowgirl ) Complete the County Award Form ) Complete the Ohio 4-H Achievement Record ) Participated in a non 4-H Youth Activity (Scouts, Church, Sports, FFA, etc). Describe the activity and what you learned. 10 Total Page 2

3 28.) Served in a Leadership position in a club/organization other than 4-H such as FFA, Band, Youth Group, etc. Name: Office: ) Invite a guest speaker to your 4-H Club meeting. Date: 10 Speaker: Topic: 30.) Exhibit your project display at your 4-H club meeting and describe your project. Project: Date: ) Describe something new you learned at a 4-H Club meeting this year ) You sent Thank You cards to all buyers of your livestock/still projects at fair ) You sent Thank You cards to the people/businesses that provided the donation for any awards you received for Showmanship, Livestock or Still Project awards ) You completed the Profit and Loss Statement in ALL of your Animal Science 10 (Livestock) record books. COUNTY AND STATE OPPORTUNITIES 35.) Participated in a county-wide fundraiser (i.e. Frozen Food Sale, Cookie Dough Sale, FIC Barbeque, etc) 36.) Participated in a 4-H week activity ) Assisted with a county-wide event. a. Livestock Knowledge Judging/Skillathon Day 10 b. Still Project Judging Day 10 c. Benefit Auction 10 d. Fund-Raiser 10 e. Kick-Off Night 10 f. 4-H Officer Training 10 g. Livestock Jamboree 10 h. Project Clinic Clinic: Date: 10 i. Date: 10 Total Page 3

4 38.) Serve as an active member on 1 of the following committees. (To be considered an "active member", you must attend 50% of that committees' meetings.) a. 4-H Advisory Committee 10 b. Still Project Committee 10 c. Small Animal Committee 10 d. Large Animal Committee 10 e. Horse Committee ) Participated in a Fair activity other than showing your project (i.e. Small Animal Dress Up, Pedal Pulls, Square Dance, Livestock Judging Team Competition). Activity: 10 Activity: ) Attended another county fair or the Ohio State Fair and I have described 10 my experience in a 250 word essay and it is attached to this application. 41.) I have submitted a 200 word essay "What 4-H Means to Me" or "Something 10 Special that Happened to Me Through 4-H" and it is attached to this application. 42.) Interviewed a 4-H Alumni or award recipient and I have written his or her story 10 in a 250 word essay and it is attached to this application. 43.) I have submitted an essay (at least 100 words) about an exceptional activity I 10 have experienced through 4-H and it is attached to this application. 44.) Attended a State-wide 4-H Opportunity such as Shooting Sports Camp, Ohio Forestry Camp or Citizenship Washington Focus. 45.) Participated at the Ohio State Fair. Project: 15 Project: 10 Project: 5 BONUS POINTS 45.) Bonus : 10 points will be given for each Excellent score & 5 points for each Very Good score that was received for up to 4 projects. Total Page 4

5 SUMMARY PAGE Name: Circle year applying for and points needed: Add up your points: 1st th th Total Page 1: 2nd th th Total Page 2: 3rd th th Total Page 3: 4th th Total Page 4: Grand Total: Check all that apply to your application. I am a 5th -11th year honor member applicant & I have attached a County Award Form. I have completed #22, "Complete the Ohio 4-H Achievement Record" and it is attached. An Essay for #40, "Attend another county/state fair" is attached. An Essay for #41, "What 4-H Means to Me" or "Something Special" is attached. An Essay for #42, "Interview a 4-H Alumni" is attached. An Essay for #43, "An Exceptional 4-H Activity" is attached. I have met all the requirements with a total of points and request consideration as a year Honor Member in the Carroll County 4-H Program. Member Signature: I hereby certify that the above applicant has met all the requirements for the honor which he/she is applying. Advisor Signature: Club: Date: It is the MEMBER's responsibility to return this form to the Extension office by the last Monday in August, signed by both the member AND his/her Advisor. UNSIGNED FORMS WILL NOT BE CONSIDERED. FOR OFFICE USE ONLY The above named applicant has met the requirements needed to receive the award of Honor Member for the 4-H Program year in Carroll County. 4-H Educator, Carroll County