Cecil County 4-H
2016 President’s 4-H Volunteer Service Award Record
Complete this form to track your service-learning hours. Community Service refers to efforts to help others and to improve your community. You can
be participating on behalf of a community, religious, and/or youth organization. It can be an individual effort or with a group such as a school-based
service learning project. This can include club projects, community events, fair activities, and 4-H Camp services. Examples of community service
include singing at nursing homes, gathering supplies for the troops, volunteering at a local hospital, purchasing items for those in need, and anything
that benefits the community for those who are not as fortunate. Things that would not count are fundraisers, unless all the proceeds are given to an
organization like the American Cancer Society or the local homeless shelter that helps others, and neither you nor your 4-H club are benefiting from the
service. As a reminder, teaching youth citizenship is one of the core goals of the 4-H program, so each club should be doing at least two community
service activities annually. Hours must be completed during the 2016 calendar year.
Return this completed form to the Extension Office by January 31, 2017.
University of Maryland Extension 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.
Date
Community Service Activity
Explanation of Community Service Aspect of Activity
Hours
Continues on Other Side
Date
Community Service Activity
Explanation of Community Service Aspect of Activity
Hours
Total Hours Served:
4-H Age
Green
Bronze
Silver
Gold
Kids 8-10
1-25 Hours
26-49 Hours
50-74 Hours
75 or More Hours
Teens 11-15
10-49 Hours
50-74 Hours
75-99 Hours
100 or More Hours
Young Adults 16-18
20-99 Hours
100-174 Hours
175-249 Hours
250 or More Hours
I verify that the above information is accurate
4-H Member Signature
Date of Submission
Address
County/Country
E-mail Address
Birth Date
Age
Parent or Guardian Signature
University of Maryland Extension 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.
Revised 3/2016