2015 President’s Volunteer Service Award Record Sheet—Montgomery County 4-H
The President's Volunteer Service Award recognizes United States citizens and permanent residents who are at least five
years old and have achieved the required number of hours of service over a 12-month period—for the Montgomery
County 4-H Program, this period starts on January 1 and ends on December 31. This form must be completed and
turned in to your club leader or the county 4-H office no later than Tuesday, January 5, 2016. Recipients receive a pin, a
certificate, and a congratulatory letter from the President of the United States.
Examples of volunteer service include: community improvement, hunger and homelessness, public safety and violence
prevention, the environment, disaster relief, health, elderly assistance, literacy and education, and youth serving youth.
There are three different levels you may earn—
AGE
bronze, silver, and gold—and there are three
Kids (5-10)
different age categories, each with different
Teens (11–15)
requirements. Remember, the award is given
based on your age on Dec. 31 of the year you
Young Adults (16-25)
earned your hours, NOT 4-H age.
Date
Bronze
Silver
Gold
26 – 49 hours
50 – 74 hours
75 + hours
50 – 74 hours
75 – 99 hours
100 + hours
100 – 174 hours
175 – 249 hours
250 + hours
What did you do?
Place of Service
Hours
Choose ONE category that best describes your volunteering: __education __healthy lifestyles __disaster services
__environmental conservation __veterans/military families __helping the economically disadvantaged __other
Name:____________________________________ Age on Dec 31, 2015:_______
Total Hours:_______
Signature:_________________________________
You may attach additional pages
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, political affiliation, or gender identity and expression.