NORTHAMPTON COUNTY 4-H MEMBERS’ COUNTY ACHIEVEMENT
RECORD [CAR]
INFORMATION FOR COMPLETING
You have 2 choices for completing this form:
1. You may print this and complete it by hand –OR2. You may fill in the blanks on your computer by typing in the information (in a
DIFFERENT FONT) in the blank areas. The form was developed in Microsoft Word
and the boxes will expand to fit your content.
As this form has already been downloaded and reformatted, you may save this form as
you go along. However, remember to save a BLANK copy first, and then type on a copy
for yourself.
Information for completing this form on the computer:
You can type on this form by tabbing from one field/area to the next and typing in the
requested information. The boxes will expand to fit your content.
Some of the fields on page 1 only require a check (ex. boy or girl).
This record should be for the current year only. It should be placed, on top, in the green
records folder (if you have previously submitted a CAR; if not, then neatly turn this form in and
you will receive a green records folder for the future) and submitted along with your reports
from previous years. If you were in 4-H but do not have reports from previous 4-H years
(i.e., you did not complete a CAR) you should include a resume in the folder to cover
those years.
The Northampton County 4-H year is from October 1 to September 30.
Add additional pages as necessary, photocopy them, print them, or call the 4-H office for
copies.
*** Here is the word file with the County Achievement Record [CAR]. Remember to save
the file first, and then do it again as a save-as to rename it for this year. Otherwise you
will not have a blank for next time.
PLEASE – do NOT use the same font in which this form was created. Type your answers
in a different font. This form has been completed in Arial font.
Also, please make sure that ALL signatures are complete on this form. Parents &
members need to sign the first page. Leader signatures are mandatory for EACH project
completed for the year; please make sure the signatures are complete BEFORE handing
in the CAR to the offices.
The CARs are due in the offices no later than 4 PM on the first Monday in October, or to
be handed-in at the Oct. leaders’ meeting that evening by the leader. No Exceptions!!!
NOTE—For 2013, please use the new County Achievement Record or reference changes
to the story guidelines in the 2013 version when updating an older version of the CAR.
NORTHAMPTON COUNTY 4-H MEMBER’S
COUNTY ACHIEVEMENT RECORD [CAR] Year _____
Name:
Address:
City, State, Zip:
Phone:
Age Last January 1st [of the current year]:
Boy:
Girl:
Date of Birth:
Number of Yrs in 4-H as a Full 4-H Member- non Cloverbud (counting this year):
Total Yrs as a Cloverbud Member (counting this year)
Mark one of the following:
Cloverbud (5 – 8 years of age)
First year member (all ages, not including cloverbud)
Junior member (8-13 years old as of Jan. 1)
Senior member (14-19 years old as of Jan. 1)
Name of Parent(s) or Guardian(s):
Name of School:
Present Grade in School:
Name of 4-H Club(s) or Group (s):
Name of 4-H Leader(s):
Primary Project Area:
I have personally prepared this report and believe it to be correct.
Date: _______
Member’s Signature_______________________________________
Date: _______
Parent’s/Guardian’s Signature: ______________________________
Why 4-H Records?
Your 4-H record is an organized presentation of what you have learned and accomplished
in 4-H. When properly kept and carefully assembled, it is a useful tool for determining
your own progress and personal growth. For persons who are not personally acquainted
with you or who have not witnessed your good work it is the best information available to
them in evaluating your growth and accomplishments in relation to other 4-H members.
Your valuable 4-H record should be accurate, complete, organized, neat, and
contain a minimum of repetition. It is the result of careful planning, conscientious
recordings of facts and figures, and the selection of the most important information. Be
sure to read the instructions. You may choose to elaborate in your story if you feel more
explanation is necessary. This report is to be typed or filled out in ink by the participant.
Remember: To the person examining your 4-H record, this is your very best!
This record should be for the current year only. It should be placed, on top, in a folder and
submitted along with your reports from previous years. If you do not have reports from
previous 4-H years you should include a resume in the folder to cover those years.
The Northampton County 4-H year is from
October 1 to September 30.
Add additional pages as necessary—either photocopy them, download them or call the
4-H office for copies.
FIRST, please contact your leader with your question; he/she should be able to help you
with this form. Then, if necessary, contact County Extension with any questions on
completing this form, or call 610-746-1970, ext. 5.
Record of Completed 4-H Projects for Year _______
A completed 4-H project requires:
 completion of project book graded by the leader
 project exhibit at 4-H Round up/Fair
 for 4-H projects in progress that will be completed in a future year indicate with an *
Example description: Completed 2 liter bottle rocket, and exhibited rocket at round-up
Project
Club
Leader Signature
Description of Project
Project
Club
Leader Signature
Description of Project
Project
Club
Leader Signature
Description of Project
Project
Club
Leader Signature
Description of Project
Project
Club
Leader Signature
Description of Project
Project
Club
Leader Signature
Description of Project
Project
Club
Leader Signature
Description of Project
Project
Club
Leader Signature
Description of Project
4-H Club and Special Activities for Year ______
4-H Club Activities
Please include club activities, offices, committee assignments, and explain your level of
involvement or leadership responsibility. For example include: community service, trip to breeding
farm or other trip, party, demonstration to another club member, etc.
4-H Special Activities
Please include all 4-H related activities, beyond those of your club, for the current year. Include a
brief description of your responsibilities and awards. List county activities first followed by
region, state, then national activities. These include projects shown for judging or display at
and beyond the Northampton County Round-up. Examples: Fashion Revue, other fairs and
shows (i.e., Blue Valley Farm Show), mall displays, petting zoos, activities where you were a judge
(team or individual) i.e. potato judging, horticulture, animal judging, communications contest,
public relations, presentations / public speaking where you gave formal presentations to your 4-H
family or others. Include activities such as prepared talks, news stories, TV, radio, exhibits,
parades, caroling, etc. Add additional pages as necessary.
Club Activities:
Community Service
Holiday Party
Scrap Book Making
Club Fund Raiser
Booth Display @ Round
up
Volunteer at Round-up
Guest Speakers
Club Trip
Club Officer
Other
Other
Other
Other
County Activities:
Adventures in
Agriculture
County Fundraiser
Tree Sale packing /
distribution
4-H Center Clean up
(spring)
4-H Round-up Fair
County Day Camp
Teen Lock-in
Achievement Banquet
Fashion Revue
Other Local Fairs /
Shows
Hippology
Horse Bowl
Club Name
Date
Description
Horse / Livestock Ethics
MQA & PQA Training
Other
Other
Other
Other
Regional Activities:
Camp Shehaqua
Regional Shooting
Sports
Other Fairs / Shows
Not in local county
Fashion Revue
Camp Counselor
Training
Hippology
Horse Bowl
Communications
Contest
District Dairy Show
Other
Other
Other
Other
State Activities:
PA State Farm Show
Wildlife Field Day
Forestry Field Day
PA State Achievement
Days
Capital Days
Teen Leadership Conf
Teen 4-H Ambassador
Training
State Horse Show
4-H USA Exchanges
Other
Other
Other
Other
National Activities:
National Congress
4-H International
Exchanges
Eastern Nationals
National Conference
Citizenship Washington
Focus Conference
4-H and Non-4-H Awards Received Year ______
List any honors/recognition awards you received, outside of project completion and
exhibition, during the current year. Include both 4-H and non 4-H awards. Examples:
County project category awards from previous year’s achievement banquet, National
Honor Society, Athlete of the Year, etc.
4-H Awards
4-H County Round-up Fair
Achievement Banquet
Club Recognition
Scholarship(s)
Non 4-H Awards
Academic Achievement
Recognition
School Clubs / Activities
Awards
School Sport Awards
Community Sports Awards
Local Fairs / Awards
Scouting Awards
Church Awards
Art / Music Awards
Dance Awards
Date
Description
Non 4-H Activities Year ______
Please include a list of activities you are involved in outside of 4-H. Include school,
church, sports, and other organizations’ activities. Give a brief description of the activity
and your involvement in the activity. If your involvement is ongoing please note that in the
date section, such as help with church Sunday school for school year 2008-2009,
otherwise list a specific date. Examples of Activities: Tour guides, school clubs, church
youth group, etc. Add more pages as necessary.
Organization Name:
Sample: Vacation Bible
school at Christ Church
Date:
Where:
Description:
June
11-15,
2008
Christ Church
In Smithville,
PA
I volunteered to help out with the vacation bible
school program this year for 15 children from 5-12
years old.
MY 4-H STORY FOR YEAR 20________
Your 4-H story is a very important part of your record. It should focus on the project(s) or activities
that convey to your readers what you have DONE and LEARNED by participating in 4-H.
Throughout your story, it is important that you focus on one or more of the five characteristics
listed below as they apply to you and your 4-H experiences:
1. Responsibilities assumed
2. Service to others
3. Qualities of good citizenship, such as group decision making, participation in club democracy,
cooperation, etc.
4. Development of personal values such as: self confidence, integrity, work ethic, responsibility.
5. Decisions about career interests.
It is recommended that your story be typed on one side per page and double spaced.
4-H Story for Cloverbuds – (1 paragraph) or a picture can be drawn if desired
4-H Story for ages 8-13 years old as of Jan 1 – at least 250 words
4-H Story for ages 14 -19 years old as of Jan 1 – at least 500 words
This publication is available in alternative media upon request.
The Pennsylvania State University is committed to the policy that all persons shall have equal access to programs,
facilities, admission, and employment without regard to personal characteristics not related to ability, performance, or
qualifications as determined by University policy or by state or federal authorities. The Pennsylvania State University
does not discriminate against any person because of age, ancestry, color, disability or handicap, national origin, race,
religious creed, sex, sexual orientation, or veteran status. Direct all inquiries regarding the nondiscrimination policy to
the Affirmative Action Director, The Pennsylvania State University, 201 Willard Building, University Park, PA 168022801; telephone (814) 863-0471; TDD (814) 865-3175.
Revised 7/2013