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Bond-Clinton-Jefferson-Marion-Washington Unit
4-H 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.
Name
Birthdate
Mo. Da. Yr.
Address
Street
Telephone
Town and Zip
Year I Joined 4-H
Club/Group
*Please note that a member my only receive points on each item one time. Repeat responses under various
categories will not be scored more than once.
* This application will also be scored on the 4-H members’ ability to communicate their ideas effectively,
organization, neatness, spelling and punctuation.
* 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 Cooperation
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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.
** Committees must have planned meetings to complete the job assigned to them. If there are activities that you helped with, but did not serve on the
committee, list these activities in the Participation section on page 8.
Number of meetings
Year
Held
after
joining
Attended
after
joining
Club officers, Junior
leader or Federation
representative
20
20
20
20
20
20
20
20
20
20
20
Total
(Put totals in pencil)
Committees worked on, and assistance to club leaders
(indicate a committee
chaired with a capital "CH")
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II.
Promotional Appearances in Support of 4-H or U of I Extension
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
20
20
20
20
20
20
20
20
20
20
20
III.
4-H Leadership in County, Multi-County, Regional, or State 4-H Programs
Indicate committees worked on and major responsibilities. Also include teaching experiences. 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
20
20
20
20
20
20
20
20
20
20
20
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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
20
20
20
20
20
20
20
20
20
20
20
School-Band
Offices held and committees chaired
Honors & Recognitions and Date
Band President
Fund Raiser - CH
Outstanding Musician
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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 Involvement &
Exhibit
Environment & Natural
Exhibit
Plants & Soils
Global Awareness
Resources
Year
20
20
20
20
20
20
20
20
20
20
20
Total
C
Del
Alt
C
Del
Alt
C
Del
Alt
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Example
Agriculture
Year
2000
Beef I
1 steer
1 heifer
corn 5 acres
Food & Nutrition
Exhibit
Del
Alt
C
Food, Nutrition
& Health
Year
Exhibit
C
You Learn to Bake (12 recipes)
Microwaving (8 recipes)
A
A
A
Exhibit
C
Del
Alt
Home & Family
A
B
Exhibit
C
Personal Development
Del
Alt
C
Del Visual Arts 4 areas
Engineering &
Technology
Del
Alt
20
20
20
20
20
20
20
20
20
20
20
Total
Have you totaled each column in pencil?
Exhibit
A
A
A
B
Exhibit
C
Del
Alt
Del
Alt
Alt
Personal
Development
& Achievement
Exhibit
C
Del
Alt
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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
20
20
20
20
20
20
20
20
20
20
20
Project
Medals
Certificates
Trophies and Plaques
Other 4-H Awards
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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.
Please include a written summary of these activities. These summaries can be in narrative or outline form.
Example: Community Service – June – Collected Canned Goods for the County Food Pantry
Program
Where Done
Achievement Program
Club
County
Agriculture
Club
County
Camping
County
County
4-H Camp
Multi-County
Career Exploration
Club
County
Citizenship (Ex.: CWF,
Legislative Ambassador,
Legislative Connection)
Club
State
National
Clothing (Fashion) Revue
County
State
Community Service
Club
County
State
Educational Tour
Club
County
Energy Conservation
Club
County
Fundraisers
Club
County
Illini Summer Academies
State
4-H Day with the ______
Multi-County
Sporting Team
Regional
State
4-H Junior Leadership
Conference
State
4-H Federation Meetings (List
No. of meetings attended)
County
4-H Scarecrow Contest
County
4-H Holiday Tree Contest
Handbook Cover Contest
County
Health
Club
County
Judging Contest (you are the Club
judge ex: livestock or state
judging contests)
County
Regional
State
20
20
20
20
20
20
20
20
20
20
20
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Program
Where Done
20
Illinois State Fair Exhibition
Award of Excellence
20
20
20
20
20
20
20
20
20
20
Superior Rating
International
Club
County
State
Livestock Auction
County
Livestock Rate of Gain
County
Officers Training
Club
County
Poster Contest
County
Window Display
Premiere Carcass
County
State
Public Speaking
Club
County
State
Recreation (Ex.: Lock-In,
skating, bowling, softball,
etc.)
Club
County
Multi-County
Safety
Club
County
List other programs and workshops sponsored by 4-H or Extension not listed above.
Program
20
20
20
20
20
20
20
20
20
20
20
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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*
20
20
20
20
20
20
Ages 15 to 18 complete 1 through 10*
20
20
20
20
1. Select a project, decide what to do in
project, complete record.
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
the county, multi-county, regional or state
level.
9. Provide leadership for a project, an
activity or for a 4-H group.
10. Assist in conducting programs at the
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
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