ILLINOIS 4-H MEMBER RECORD
This record is a summary of all 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_____________________________________BIRTH DATE_____________________________________
Month
Day
Year
ADDRESS_________________________________________________________________PHONE____________
911 Address
Town
Zip
CLUB OR GROUP__________________________________________________YEAR JOINED 4-H_________
1. PARTICIPATION IN THE LOCAL CLUB
Begin with your First Year in 4-H and List Number of Meetings Held, Number attended, Offices Held, and
Committee Participation in your Local Club. REMEMBER-You must attend 2/3 of the scheduled meetings to be
eligible to show in the County Fair!
4-H
Year
Meetings Meetings
held
attended
after
after
joining
joining
Club
Offices
Held
Committees Worked On (indicate the
committee chaired with a capital “CH”)
20092010
20102011
20112012
20122013
20132014
20142015
20152016
20162017
20172018
20182019
2.
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2. 4-H PROJECTS - ENROLLMENT AND EXHIBITS
Begin with your First year in 4-H and list your Project(s) by Year. Use only ONE ROW for each YEAR and
ONE COLUMN for each PROJECT. List the Project Name at the top of the appropriate column. Indicate the
project unit, total size of your project, what you exhibited, and all other work done, including: articles, animals,
recipes, meals, etc. (Refer to the Clover for a list of Projects) List County exhibit ratings in the “C” Column,
and State ratings in the “S” Column. Additional Inserts are available from your Leader or the Extension Office.
Year
Project
Exhibit
C S
Project
Exhibit
C S
Project
Exhibit
C S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
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Example
Year
20092010
Year
Project
Visual Arts
Clay (2Items)
Wood (1 Item)
Project
Exhibit
C
S
A
B
Exhibit
C S
Project
Swine
Swine 1
(4 Pigs)
Project
Exhibit
C
S
A
Project
Horticulture
Flower Arranging (2)
Vegetables
Exhibit
C S
Project
Exhibit
C
S
A
S
A
Exhibit
C S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
C
S
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3. PARTICIPATION IN 4-H PROGRAMS
For Each year, record the month in which you participated in each program, simply write the abbreviation in the
appropriate box. The Column “Location” refers to where you participated in the program. “Club” refers to what
you did on your own or in a program that several or your entire 4-H group participated in. “County” refers to
programs offered on the county level. “Multi-County” refers to programs offered for 2 or more counties.
“Regional” refers to programs offered by the Extension region. “State” refers to Statewide programs, “National” to
a national program. Extra work in a program can be recorded in a written summary. If you prepare a written
summary, place an asterisk (*) in the appropriate column, and attach the summary to the back of this record.
PROGRAM
Demonstrations
And Talks
LOCATION
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
Club
County
State
Club
Public
Speaking
County
State
National
Recreation
Club
County
Club
Safety (Farm,
Bicycle, etc.)
County
State
Club
Health
County
State
Community
Service
Club
County
Club
Camping
County
State
Flower
Arranging
Achievement
Night
Workshops /
Clinics
County
County
County
Regional
County
Judging
Contests
Regional
State
National
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PROGRAM
LOCATION
2009
2010
2011
2012
2013
2014
2015
2016
2017
2017
2019
2016
2017
2018
2019
Club
Fair
County
State
Animal
Showmanship
Classes
Legislative
Conference
Leadership
Conference
Other 4-H
Conferences
Space Camp
County
State
National
State
State
Regional
State
Club
Junior Leader
County
State
County
Officer
Training
Regional
State
County
Project
Workshops
Regional
State
Federation
Member
County
OTHER PROGRAMS NOT LISTED ABOVE
Program
Location
2009
2010
2011
2012
2013
2014
2015
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4. 4-H LEADERSHIP
(CLUB, COUNTY, REGIONAL, STATE, AND NATIONAL)
Year
List your Specific Responsibilities, and in parentheses, indicate the number of members assisted
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5. COMMUNITY ACTIVITIES
Summarize what you have done in your school, community, and church activities. In the “Other” Column, list
individual activities such as Sunday School Teacher, Drum Major, etc.
Year
Membership in groups and
organizations
Offices Held and
Committees
Chaired
Honors and
Recognitions
Other
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6. HONORS AND RECOGNITIONS RECEIVED IN 4-H
List the medals, certificates, savings bonds, trophies, gifts, grand champions, plaques, etc. received.
Do not list Blue, Red, or White ribbons. Please include the year.
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APPROVAL SIGNATURES
Signatures REQUIRED to be eligible for Awards!
Year
Member Signature
Parent or Guardian
Signature
Leader Signature
20092010
20102011
20112012
20122013
20132014
20142015
20152016
20162017
20172018
20182019
Revised 2005-2006 by SSD
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