Garrett County Office
1916 Maryland Highway, Suite A
Mt. Lake Park, MD 21550
Phone: 301-334-6960
Fax: 301-334-6961
www.extension.umd.edu/garrett-county
4-H Member’s Name:
Date:
4-H Club:
Birth Date:
4-H Age:
2016 President’s 4-H Volunteer Service Award Record
Complete this form to track your service-learning hours. Service hours should include efforts to help
others who are outside of your family and to improve your community. Your work can be as an individual
or as part of as a group project. This could include club service projects, volunteering your time to help
at community events, fair clean-up, and serving as a teen leader such as camp counselor or workshop
coordinator. Hours must be completed during the 2016 calendar year. Hours are measured over a 12month period and awards are designated based on cumulative hours. To earn the service award you must
have completed the hours listed below:
President’s 4-H Volunteer Service Awards
4-H Age (As of Jan 1st)
Kids (8-10)
Teens (11-15)
Young Adult (16-18)
Bronze
26-49
50-74
100-174
Silver
50-74
75-99
175-249
Gold
75+
100+
250+
Return the completed form to the UME Garrett Office by January 15, 2017
Date
What I did to help:
Location
Hours
ssssssssss
Revised 02/16/2016
The University of Maryland, College of Agriculture and Natural Resources programs are open to all and will not discriminate against anyone because of race, age, sex, color, sexual orientation,
physical or mental disability, religion, ancestry, or national origin, marital status, genetic information, or political affiliation, or gender identity and expression.
Sub-Total Hours Earned:
Date
What I did to help:
Location
Total Hours Earned:
I verify that the above information is accurate.
4-H Member Signature ______________________________________ Date ____________
Parent or Guardian Signature ________________________________________________
Hours