2015
Clinton County 4-H Award Application Cover Page
If this Award Application is turned in hand written it must be in the member’s writing only.
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Procedure:
Submit one completed copy of the award application for each award category.
Fill out this form. Please mark age group and check only one award category per award
application.
Turn in to Club Leader’s by the last Friday in August. Leader’s will submit applications to
the office after they are signed. Applications missing approval signatures will not be
considered.
Applications that are not filled out correctly will be returned to the leader/member to be
redone.
Re-do applications will have three days to return the application for grading.
Age Group as of Sept 1, 2014: 8-11___ 12-14___15 &
up________ You must check one age group!
PLEASE DECLARE THE PROJECT AWARD AREA YOU ARE APPLYING FOR BY MARKING IN THE BLANK
PROVIDED. IF NO PROJECT AWARD AREA IS MARKED, THE APPLICATION WILL BE RETURNED TO YOU!
Food, Nutrition & Health
__All Foods & Nutrition projects
__Cake Decorating
__Candy Making
__Health
__Sports
Animal Science
__Beef
__Cat
__Dairy
__Dog
__Goat
__Horse & Pony
__Poultry
__Rabbit
__Sheep
__ Small Animal/Small
Pets
__Swine
__Vet. Science
Engineering & Technology
__Aerospace
__Bicycle
__Computer Science
__Electricity
__Geospatial
__Robotics
__Small Engines
__Tractor
__Video/Filmmaking
__Welding
__Woodworking
Community
Involvement & Global
Awareness
__Citizenship
__Intercultural
__Service Learning
Environment & Natural Res.
__Camping
__Entomology
__Forestry
__Geology
__Natural Resources
__Sportsfishing
__Wildlife
Plants & Soils
__All Crops Projects
__Floriculture
__Horticulture
__Plant & Soil Sciences
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Home & Family
__Child Development
__Consumer Education
__Entrepreneurship
__Intergenerational
__Interior Design
__Sewing & Textiles
Personal Development
__Communications
__Leadership
__Photography
__Theater Arts
__Visual Arts
__Collections (scrapbooking/farm
models)
__Reading
2015 Clinton County
4-H Member Award
Application
This record is a summary of what you have accomplished in 4-H this year.
Read all instructions at the beginning of each section carefully. This record will
be used in evaluating your progress for the year and will be the basis for award
selection.
Name
BIRTHDATE
NUMBER OF YEARS IN 4-H
Statement by Member
I personally have prepared this application and certify that it accurately
reflects my work.
Signature of 4-H
member
Date
Approval of This Report
We have reviewed this application and believe it to be correct.
Signed
(Parent)
Date
Signed
(Leader)
Date
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4-H Project - Exhibits
County Rating mark all that apply for this project area.
Blue
Red
White
State Fair
State Fair Alternate
Best of Show
Special Honors for animal shows
(Knowledge and Skills –List five things you learned in this project (5 pts. each/25 pts. max)
Example:
to to
think
ahead
when
cutting
outout
patterns
forfor
mymy
sewing
project.
Example:I learned
I learned
think
ahead
when
cutting
patterns
sewing
project. _
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List all the events you participated in this year under 4-H club,
County, State or Community/School/Church Headings. You may only
list an activity only once!
PARTICIPATION IN 4-H Club ACTIVITIES
(1pt each/ 20 pts. max)
Example: Attended December Meeting.
Example: Gave a talk/demonstration on cooking.
List Club Activities:
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PARTICIPATION IN 4-H County ACTIVITIES
(1pt each/ 20 pts. max)
Example: Attended Sewing Workshop.
Example: Attended Award Ceremony.
List County Activities:
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PARTICIPATION IN State 4-H ACTIVITIES
(1pt each/ 10 pts. max)
Example: Attended State Fair.
Example: Attended Junior Leadership Training.
List State Activities:
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PARTICIPATION IN COMMUNITY/SCHOOL/CHURCH ACTIVITIES
(1pt each/10 pts. max)
Example: Attended/Performed in Band Concert
List all the community/school/church activities you participated in this year. DO NOT include
4-H activities on this page.
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LEADERSHIP (1 pts. each/ 20 pts. max)
Leadership &
Committees is described as anything that you TAUGHT, PLANNED
or CONDUCTED which involved a group of any size. This covers 4-H,
On this page list all your leadership responsibilities that pertain to this year.
community, school, and church leadership responsibilities. In the column on the right use the letter
Helping or assisting with a
program does not meet the definition of leadership.
that represents which area of leadership was performed.
Example: Planned and conducted the Valentine’s 4-H Party.
Example: Taught 4-H pledge to Cloverbud members.
Example: Served on the refreshment committee.
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OFFICE HELD
Club (5) County (5) State (10)
List office held and check level served
Example: Federation Reporter (awarded 5 pts)
Example: President of 4-H Aviston Ace (awarded 5pts)
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MY 4-H STORY (up to 60 pts.)
Your story is an important part of your award application. It gives you the opportunity to
highlight what you feel is your most important accomplishments during the 4-H year. You
can tell about how 4-H has contributed to your self-respect and concern for others or how
4-H has boosted your confidence and attitude in life. If 4-H has helped you become a better
leader and citizen talk about it here. Do not include your name, or club name in your 4-H
story. Write an age appropriate story.
Judging will be based on the following criteria
I. Size and Growth (15)
Project area & years in that project
II. Knowledge Gained (15)
Successes and failures
III. The impact this project or the impact 4-H has had on your life (30)
Leadership examples
Personal Development examples
Story Score:
Total Award Application Score:
Judges Notes:
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