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 - 75 2nd - 100 3rd - 125 4th - 150 5th - 175 6th - 200 7th - 225 8th - 250 9th - 275 10th/11th - 300 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. 10 2.) I've had no more than 1 unexcused absence from a regularly scheduled meeting. 10 3.) 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 Showmanship @ fair f. Livestock Jamboree o. Helped build the fair booth @ fair g. Benefit Auction p. Project Clinic (Name & Date below) h. Quality Assurance Total pts #7 i. Still Project Quality Assurance Total Page 1
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: 10 10.) Provided leadership to another 4-H member. Who: 10 11.) Participated in club fundraiser. Describe: 10 12.) Completed a project I've never tried before. 10 13.) Completed at least 4 projects during the current 4-H year. 10 14.) Recruit 1 new member. Name: 10 15.) Recruit 1 new advisor. Name: 10 16.) Serve on the Junior Fairboard. 15 17.) Serve as a camp counselor or CIT. 10 18.) Be an active member of the Teen Leaders Club. 10 19.) Give a demonstration before 10 or more people other than your 4-H club. 10 20.) Give a presentation about 4-H to another organization. Name: Date: 10 21.) Participate in an activity during 4-H week. 22.) Complete the interview process for Outstanding Court. 5 23.) Complete the interview process for Fair King/Queen. 5 24.) Complete the interview process for Cowboy/Cowgirl. 5 25.) Complete the County Award Form. 10 26.) Complete the Ohio 4-H Achievement Record. 20 27.) Participated in a non 4-H Youth Activity (Scouts, Church, Sports, FFA, etc). Describe the activity and what you learned. 10 Total Page 2
28.) Served in a Leadership position in a club/organization other than 4-H such as FFA, Band, Youth Group, etc. Name: Office: 10 29.) 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: 10 31.) Describe something new you learned at a 4-H Club meeting this year. 10 32.) You sent Thank You cards to all buyers of your livestock/still projects at fair. 20 33.) 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. 20 34.) 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. 10 37.) 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
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 10 39.) 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: 10 40.) 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
SUMMARY PAGE Name: Circle year applying for and points needed: Add up your points: 1st - 75 5th - 175 9th - 275 Total Page 1: 2nd - 100 6th - 200 10th - 300 Total Page 2: 3rd - 125 7th - 225 11th - 300 Total Page 3: 4th - 150 8th - 250 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