Name: Age as of January 1, 20 years old Complete Address: Town/State/Zip Code: Number of years in 4-H (Including this year): School Grade: Name of Club: Years Enrolled ~ Project Summary (Include all projects for all years) Example: Foods 3 Years 2008-2010 I have personally prepared this report and believe it to be true and accurate. Date: Date: Date: Signature of Member Signature of Parent/Guardian Signature of 4-H Leader SPECIAL INSTRUCTIONS: When presenting information on the following pages, BE BRIEF in the various sections of this book, and respond in the form of a numbered list, not in paragraph form. 1 P a g e
LOCAL CLUB OR GROUP RESPONSIBILITIES --- THIS YEAR Number of members in your club: Regular Members: Cloverbud Members: Number of business meetings held by your club starting from September 1: How many meetings did you attend? List 4-H Offices you held and the committees you served on: Office or Committee Your Responsibilities List participation in club meetings for this year. For example: Gave a demonstration, led the pledge, taught a game, gave a committee report, helped clean up after meeting, arranged meeting room, etc. CITIZENSHIP / COMMUNITY SERVICE EXPERIENCES List citizenship and community service experiences that you have had this year only. Total Community Service Hours 2 P a g e
PARTICIPATION IN 4-H PROGRAMS/ ACTIVITIES (check all you participated in) County Events: National 4-H Week County Window Display Achievement Banquet Junior Council Meetings County Demonstration Day Great Pumpkin Day Younger Member Weekend Compact Tractor Driving Junior Leader Weekend Exchange Group Public Speaking Contest Favorite Foods Contest 4-H Summer Day Camp 4-H Science Camp County Clothing/Textile Showcase County Sewing Contest Trainings: Favorite Foods Contest Training State Record Book Training County Record Book Training Club Officer Training Demonstration Contest Training Public Speaking Training Day Camp Counselor Training Poultry Judging Training Photography Judging Training Horse Judging Training Horticulture Judging Training Wildlife Judging Training Livestock Judging Training Horticulture Judging Training Woodworking Judging Training Dairy Judging Training Judging Contests: Dairy Judging Contest Poultry Judging Contest Woodworking Judging Contest Photography Judging Contest Foods Judging Contest Horticulture Judging Contest Wildlife Judging Contest Clothing Judging Contest Horse Judging Contest Livestock Judging Contest Other Events: State Environmental Camp Equine Arts Contest State 4-H Camp Cow Camp Holiday Ice Skating Party 4-H State Teen Conference State Horse Bowl Contest Livestock Exposition 4-H Legislative Day National 4-H Dairy Conference National 4-H Congress National 4-H Conference PQA Training Delaware State Fair State Judging Contests State Demonstration Contest State Talent Show State Public Speaking Contest 4-H Consumer Bowl 4-H Lawn Tractor Driving 4-H Tractor Driving 4-H Archery Competition 4-H Avian Bowl 3 P a g e
Kent County Events: County Litter Barrel Cloverbud Fun Day County Livestock/Jackpot Show Pygmy Goat Show County Trim a Tree Teddy Bear Drive Holiday Fun Day International Foods Share The Fun Talent Show Livestock Overnighter Winter Fun Day Livestock 101 Social St Patrick s Day Parade Old Dover Days Parade Photography Contest Basket Auction Kent County 4-H Horse Show 4-H & FFA Spring Dairy Show County Science Club County Tech Team County Robotics Club Sussex County Events: Pedal Pusher Bike Rides Coastal Clean Up County Archery Training/Shoots County Robotics Club Pumpkin Contest Younger Member Fall Retreat International Foods 4 Little Clovers Talent Show Photography Contest Computer/Graphic Arts Contest Winter Fun Day Holiday Cards for Soldiers Hopkins Farm Tour Sussex County 4-H Horse Show New Castle County Events: NC County Livestock Show Winter Workshops Attended: Younger Member Fun Day Quest for the Clover 5K Shooting Sports Day AG Day Holiday Clothing Drive Ronald McDonald House Kit 4 P a g e
PARTICIPATION IN LOCAL CLUB EVENTS List activities and events that you participated in at the club level. Do not duplicate events that have already been reported in other sections on this form. CLUB, COUNTY and/or STATE 4-H LEADERSHIP EXPERIENCES--- THIS YEAR 1. Are you a member of the County Junior Council? Number of meetings attended: 2. List your leadership participation in the county or state program. (Example: Member of planning committee, MC, Sold Ads for County Horse Show, host/hostess in 4-H Building, etc.) 3. Are you a Junior Leader? What are your responsibilities in your club or on the county level? 5 P a g e
4. How have you assisted other members in your club or on the county or state level? 5. List other leadership experiences you have had this year in 4-H. EXPERIENCES AND AWARDS OUTSIDE OF 4-H List and explain important things, other than 4-H, that you have done in school, church, or other groups in your community, county, or state. 6 P a g e
DOCUMENTING YOUR PROJECT Use this page to record more detail about your general 4-H year. Use pictures, samples, etc. Do not shingle or overlap items. You may add one additional page for a total of 2 pages for this section. You are permitted to have photos on the front and back of each page. 7 P a g e
MY 4-H STORY Include a narrative of the past year s 4-H work that describes your successes, failures, and experiments. This writing should not exceed 500 words. last updated 4-22-14 8 P a g e