20__ 4-H Club Charter Renewal Application
All 4-H Club Charters must be renewed on an annual basis. To apply for renewal of a 4-H club’s charter, the organizational
leader of a 4-H club must submit this application, along with the appropriate documentation (listed below) to the local
University of Maryland Extension (UME) 4-H Office. Application and supporting documentation should be submitted to the
Local UME Office by January 31st. They will review and then forward to the Maryland 4-H Youth Development Program
for approval.
Name of 4-H Club: ____________________________________________________________________________________
Club Organizational Leader: ____________________________________________________________________________
Address: ____________________________________________________________________________________________
Phone: ___________________________ Email: ____________________________________________________________
Club #: _______________________________ Local UME Office: _____________________________________________
For Extension Office Use
Maryland 4-H Club Charter Renewal Requirements:
Only:
Attachment Included?
1. The club has a federal EIN tax number. EIN # ______________________________
(Military clubs or afterschool programs in which certification for tax purposes are
obtained through other entities must complete the 4-H Club Additional Financial Entity
form and attach.)
2. The club has filed the appropriate 990 or 990 N and a copy of confirmation is attached.
(not required of military clubs or afterschool programs in which certification for tax
purposes is obtained through other entities)
3. The club has at least five members from three different families and a list of members is
attached.
 Yes  No
 Yes  No  N/A
4. The club has at least two trained UME volunteer leaders and a list of leaders is attached.
 Yes  No
 Yes  No
5. The club has elected and trained youth officers and a list of officers is attached. (not
required of Clover Clubs)
 Yes  No  N/A
6. The club has adopted bylaws and a copy is attached.
 Yes  No
7. The club has completed the Maryland 4-H Foundation Affiliation Agreement for 4-H
Clubs and a copy is attached.
(not required of military clubs or afterschool programs in which certification for tax
purposes is obtained through other entities)
 Yes  No  N/A
8. The club has developed an annual program plan that provides a variety of learning
experiences and a copy is attached.
 Yes  No
9. The club is in compliance with the Affirmative Action guidelines and a copy of Public
Relations Efforts by Clubs Form AA-4H/HE4 is attached.
 Yes  No
10.The club plans to hold at least 6 meetings per year.
 Yes  No
University of Maryland Extension, 4-H Club Charter Renewal Application, page 1/2
11. The club has completed a Financial Report and a copy is attached.
(not required of military clubs or afterschool programs in which certification for tax
purposes is obtained through other entities)
12. The club has completed the 4-H Property Inventory Report and a copy is attached.
 Yes  No  N/A
 Yes  No
Our 4-H club understands that the use of the 4-H name and emblem is protected by federal law. I certify that this 4-H club
fully meets the requirements to be a 4-H authorized group and respectfully request to renew our official 4-H Charter in order
to continue to operate as a legal 4-H entity.
President: ___________________________________________________________________________________________
Name
Signature
Date
Club Organizational Leader: ____________________________________________________________________________
Name
Signature
Date
Extension Educator: ___________________________________________________________________________________
Name
Signature
Date
For Maryland 4-H Center Use Only:
______This 4-H club is approved for full renewal of its charter for the 4-H year _____________
______ This 4-H club is temporarily placed on probation for up to three months beginning ____________ and being
reviewed no later than _____________ due to _______________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
______This 4-H club’s charter is revoked as of this date ________________ due to ________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Official Signature: ____________________________________________ Date Reviewed by 4-H Center: ______________
Upon final review of this renewal application by the local Extension Educator, the club should be notified of its status. This
application should be filed and kept for a period of three years in the local UME office.
Revised 9/13
University of Maryland Extension programs are open to all persons 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.
University of Maryland Extension, 4-H Club Charter Renewal Application, page 2/2