Page 1
Washington County
Member Record
This record is a summary of all of 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.
SAMPLE
Name
Birthdate
Mo. Da. Yr.
Address
Street
Telephone
Town and Zip
Year I Joined 4-H
Club/Group
* The 4-H Name and Emblem are Protected Under 18 U.S.C. 707.
University of Illinois Extension at Urbana-Champaign provides equal opportunity in employment and programs
for all persons, and prohibits discrimination because of race, religion, color, age, handicap, sex or national origin.
State  County  Local Groups  USDA Cooperating
Page 2
I.
Participation in Local 4-H Club or Group
Begin with your first year in 4-H and list meetings held, meeting you attended, offices held and committee participation in your local club or group.
Number of meetings
Year
Held
after
joining
Attended
after
joining
Club officers, Junior
leader or Federation
representative
Committees worked on
(indicate the committee
chaired with a capital "CH")
1997
12
1998
12
11
Recreation
Window Display, Poster Cmte
1999
12
10
Recreation
Paper Drive Cmte, Float Cmte
2000
12
11
2001
12
12
12
Window Display
Auction Food Stand, Blood Drive Cmte, Window Display (CH)
Reporter
Nursing Home Christmas Program Cmte, Window Display
Float Cmte (CH), Window Display,
2002
12
10
Secretary
Poster Cmte, Aluminum Drive Cmte
2003
12
11
President
Recycling Cmte, Float Cmte, Food Pantry Project
2004
12
12
Jr. Leader
Project 4-H Home Tour (CH), Window Display
2005
2006
2007
Note: Above activities are club projects, etc.
Total
(Put totals in pencil)
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Promotional Appearances in Support of 4-H or U of I Extension
II.
Presentation to non-4-H groups or appearances on radio or television related to the 4-H program.
Indicate topic presented and audience reached. Include any recognition for the groups special projects.
Ex: Promotional booth at festival.
Year
Appearance, Event or Program
Audience
Live
Radio
TV
1997
1998
June Dairy Month
Club - Kroger Grocery Store
X
1999
Club Project Show
HEA
X
Radio Audience
2002
Community Service Project
Radio Spot
4-H Display Booth
Wheat Festival
X
2003
Float
Centralia Parade
X
2004
Federation Summer Trip
Work in "House of Cans"
Show Me St. Louis
Washington County Fair
X
2000
2001
WNSV
KSDK
2005
2006
2007
III.
4-H Leadership in County, Multi-County, Regional, or State 4-H Programs
Indicate committees worked on and major responsibilities. Mark County (C), Multi-county (M), Regional (R), State (S) with appropriate letter.
Begin using this section as you become involved in 4-H beyond club level. Club leadership is recorded on page 2.
Year
1997
1998
(C) Achievement Night Refreshments
1999
2000
(C) Landscape Project
2001
2002
(M) Meteor Shower Campout Planning
(M) Officers Training (CH)
2003
(C) Day Camp
(S) State 4-H Youth Council
2004
Federation Reporter
2005
2006
2007
Window Display (CH)
Trip Planning Committee
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Community Activities
IV.
Summarize what you have done in your school, community, and church activities (EX: band, FFA, choir, church, Scouts, civic group).
Participation in school, community
or church groups
Example:
2001
Offices held and committees chaired
Honors & Recognitions and Date
Band President
Fund Raiser - CH
Outstanding Musician
School-Band
1997
Cub Scouts
1998
Cub Scouts, basketball
Outstanding Reading Award
1999
2000
Boy Scouts, Church Choir,
School Band
2001
Boy Scouts
Baseball - Most Improved
Basketball
Baseball
2002
Boy Scouts
Team Co-Captain
A-Team Basketball
2003
Marching Band, School Play
Star Scout - Badge
Regional Champions
Set Designer
Freshman Football
JV Scholar Team
2004
Biology Club, FFA, Band
Chorus
JV Football
2005
2006
2007
FFA Secretary
Chapter Award
Page 5
4-H Projects - Enrollment and Exhibits
V.
Begin with your first year in 4-H and list your projects by curriculum area. Use one row (across) for each year and one column (down) for each
curriculum area. List the project name in the appropriate column. Indicate the project unit, total size of your project, what you exhibited, and all other
work done including articles, animals, recipes, etc. (Refer to the 4-H Clover for a list of curriculum areas and project units.) Total the project column in
pencil. List county exhibit ratings (A,B,C) in column C and judges’ delegate or alternate exhibit selections (Del or Alt) in Del/Alt column. Additional
inserts of this page are available from your 4-H leader.
Animal Science and
Exhibit
Community & Global
Exhibit
Environment & Natural
Exhibit
Resources
Plants & Soils
Year
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
Total
C
Del
Alt
C
Del
Alt
C
Del
Alt
Rabbits
A
1 Heifer - beef
A
1 Heifer - beef
A
1 Yearling steer - beef
A
Beef cow
A
Geology
A
Market steer - beef
A
Camping & outdoor living
A
1 Market steer - beef
B
Dog
A
1 Yearling steer - beef
A
1 Market steer - beef
A
Dog
A
1 Cow - beef
B
Forestry
A
alt
1 Market steer - beef
A
1 Heifer - beef
A
Conservation
A
del
1 Market steer - beef
A
1 Heifer - beef
A
1 Cow - beef
B
1 Market steer - beef
A
Citizenship I
A
del
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Example
Agriculture
Year
Exhibit
Year
Exhibit
Del
Alt
C
Food & Nutrition
Food & Nutrition
Exhibit
C
C
Home & Family
Del
Alt
Exhibit
C
1997
1998
Personal Development
Del
Alt
Mechanics &
Technology
Del
Alt
Exhibit
C
Exhibit
C
Del
Alt
Personal
Development
Del
Alt
Exhibit
C
Rocket
A
Visual Arts painting
A
2 Rockets
A
A
Bicycle
A
Visual Arts basket
Visual Arts ceramics
A
1999
Del
Alt
del
Photography
2000
Computer I
2001
2002
2003
2004
Tricks for Treats
A
You Learn to Bake
A
del
Interior Design
A
2005
2006
2007
Total
Have you totaled each column in pencil?
A
Public
presentation
A
Visual Arts metal work
A
Visual Arts nature craft
A
Visual Arts painting
A
alt
del
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Honors and Recognition Received in 4-H
VI.
Over and above A,B and C project ribbons, and State Fair delegate and alternate selections.
Include medals, certificates, trophies, etc. from Achievement night; grand champions, showmanship, etc.
from 4-H shows and individual awards from 4-H activities and programs.
Year
Project
Medals
Certificates
Trophies and Plaques
Other 4-H Awards
1997
Top First Year Member
Achievement Member
1998
First Poster Contest
Achievement Member
Top Second Year Member
1999
Jr. Showmanship Trophy Achievement Member
2000
Public Presentation
Plaque
Achievement Member
Dog Care Trophy Grand
Champion
Achievement Member
2001
Animal
Science Medal
2002
Animal Science -Blue Award
Achievement Member
2003
Environment & Animal Science - Blue Award
Natural
County Outstanding 4-H
Resources Member
Medal
Achievement Member
2004
Animal Science - Blue Award
Achievement Member
Environment & Natural
Resources - Blue Award
2005
2006
2007
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Participation in 4-H Programs
VII.
For each year, record the month you participated in each of the programs. The column "where done" refers to where you participated in the program.
"Club" refers to what you did on your own or in a program that several or all of your 4-H group participated in. "County" refers to 4-H programs offered
on the county level. "Multi-county" refers to 4-H programs offered for two or more counties. “State” refers to those programs offered at state level.
Extra work in a program can be recorded in a written summary. These summaries can be in narrative or outline form. If you prepare a written summary,
place an asterisk (*) in the appropriate column and attach the summary to the back of this record.
Program
Where Done
Achievement Program
Club
County
Camping
1997
1998
1999
2000
2001
Aug.
Aug.
Aug.
Aug.
Aug.
Nov.
Nov.
Nov
2002
2003
2004
Aug.
Aug.
Aug.
Nov.
Nov.
Oct.
Club
Aug.
County
Southern Illinois 4-H Camp
Multi-County
Career Exploration
Club
June
June
Oct.
County
Citizenship (Ex.: CWF,
Legislative Ambassador,
Legislative Connection
Club
Apr.
State
National
Clothing (Dress) Revue
County
State
Community Service
Club
Dec.
Dec.
May
Mar.
Sept.
County
State
4-H Leadership Conference
State
4-H Junior Leadership
Conference
State
E.D.G.E. Conference
State
Teen Retreat
County
June
Jan.
Regional
8
4-H Federation Meetings (List
No. of meetings attended)
County
Health
10
Club
County
Apr.
Judging Contest (you are the Club
judge ex: livestock or state
judging contests
County
Apr.
May
Regional
May
May
June
State
Illinois State Fair Exhibition
July
Award of Excellence
July
Superior Rating
International
Club
County
State
Poster Contest
County
Public Speaking
Club
County
State
Oct.
Nov.
Dec.
Oct.
Mar.
Mar.
Apr.
May
May
June
May
2005
2006
2007
Program
Where Done
1997
1998
1999
2000
Recreation (Ex.: Lock-In,
skating, bowling, softball,
etc.)
Club
Aug.
Aug.
Aug.
County
Nov.
Nov.
Nov.
2001
Aug.
Aug.
2002
2003
2004
2005
Aug.
Aug.
Aug.
Nov.
Nov.
Nov.
July
July
July
2006
Multi-County
Safety
Club
County
Share-the-Fun/Performance
Showcase
County
State
X-tra Yield
County
Premiere Carcass
County
State
Rate of Gain
July
County
July
July
List other programs and workshops sponsored by 4-H or Extension not listed above.
Program
1997
1998
Beef Workshop
May
Officers Training
Jan.
1999
Simply the Best
Apr.
Woodworking Workshop
Feb.
Officers Training
2000
Apr.
2001
2002
2003
2004
2005
2006
2007
Apr.
Jan.
University of Illinois Extension at Urbana-Champaign provides equal opportunity in employment and programs
for all persons, and prohibits discrimination because of race, religion, color, age, handicap, sex or national origin.
State  Local  County Groups  USDA Cooperating
Page 9
2007
Page 10
Developed for Perry and Washington Counties
2004 revision
Page 11
Standards of Excellence Check-List
Standards to be reached to be an Achievement Member:
Ages 8 to 11 complete 1 through 4
Ages 12 to 14 complete 1 through 7
1997
1998
1999
2000
2001
Ages 15 to 18 complete 1 through 10
2002
2003
2004
2005
2006
1. Select a project, decide what to do in
project, complete record.
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2. Attend at least 2/3 of club meetings after
enrolling (or number determined by club
or club leader).
3. Give a talk or demonstration or
presentation at club level.
4. Exhibit a project at the 4-H show.
5. Serve on a club committee or hold a
club office.
6. Participate in a community service activity
or in a learning activity in the community.
7. Assist leaders with a special club activity,
tour or program.
8. Participate in a 4-H learning experience at
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the county, multi-county, regional or state
level.
9. Provide leadership for a project, an
activity or for a 4-H group.
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10. Assist in conducting programs at the
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county level or beyond.
* Note:
4-H’ers MUST BE Achievement Members (Standards of Excellence Check-List)
according to age group to qualify for awards.
We have reviewed this record:
Year
20
20
20
20
20
20
20
20
20
20
20
Member’s Signature
Parent’s Signature
Leader’s Signature
2007