Edwards County 4-H
Permanent Member Record
This record is a summary of your accomplishments throughout your 4-H career. This record can be
used for evaluating your progress and planning future work. It will also be the basis for award
selection.
Name________________________________________ Date of Birth _______________
Address
______________________________________________________________
Street
County
______________________________________________________________
City
State
Zip
Phone
Club Name ___________________________________________Year I joined 4-H ________
Participation in Local 4-H Club
YEAR
Total
Number of Meetins
Attended
Held after
after
joining
joining
Committees
Club Office Held
(Put totals in pencil)
(If you chaired a committee, designate
with a capital “CH”)
II. 4-H Projects – Enrollment and Exhibits
Begin with your first year in 4-H and list your projects by year. Use one row for each year and one column for
each project. List the project name at the top of 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. Total the
project column in pencil. List county exhibit ratings in column “C” and state exhibit ratings in column “S.”
Additional inserts of this page are available from your 4-H leader.
Year
TOTAL
Project
Exhibit
C
S
Project
Exhibit
C S
Project
Exhibit
C
S
Year
TOTAL
Project
Exhibit
C
S
Project
Exhibit
C S
Project
Exhibit
C
S
PROGRAM
Achievement
Program
Animal Showmanship
Class
Automotive Contest
Camping (Ex.
Younger, older,
conservation, forestry)
Career Exploration
Citizenship (Ex.
Shortcourse)
Clothing Revue
Community Resource
Development
Community Service
Dairy Conference
Decorating for Teens
Demonstrations
(including Horticulture
Contest)
Electricity
4-H Conference
4-H Federation
Flower Arrangement
Contest
Health
Judging
WHERE DONE 20
Club
County
County
Multi-County
State
County
State
National
Club
County
Multi-County
State
Club
County
Club
Regional
Club
County
State
Club
County
Club
County
National
State
Club
County
State
National
Club
County
Multi-County
State
State
County
Regional
County
State
National
Club
County
Club
County
Multi-County
State
National
20
20
20
20
20
20
20
20
20
PROGRAM
Junior Leader
Conference
People-to-People
Poster Contest
Public Speaking
(Including Speaking of
Horticulture)
Rallies/Carnivals
Recreation
Safety
Share-The-Fun
Share-The-Fun M.C.
Sports
Tractor Operators
Contest
X-TRA Yield
WHERE DONE 20
20
20
20
20
Club
County
Club
County
State
County
State
Club
County
State
National
County
Multi-County
Club
Club
County
National
County
State
County
State
County
Regional
State
County
State
National
County
State
LIST OTHER PROGRAMS AND WORKSHOPS NOT LISTED ABOVE
20
20
20
20
20
IV. 4-H Leadership
Year
Experience as a Junior or Teen Leader
List your specific responsibilities and in ( ) indicate the number of members assisted.
20
20
20
20
20
20
20
20
20
20
Leadership in County, Multi-County, Regional, or State Programs
Indicate major responsibilities with appropriate letter: County (C), Multi-County (M), Regional (R), State (S)
Year
20
20
20
20
20
20
20
20
20
20
Offices
Committees worked on (Indicate
chairman)
Additional leadership responsibilities specific
V. Community Activities
Summarize what you have done in your school, community, and church activities. In the column, “other
participation,” tell what you did in groups or organizations to which you belong, other than offices held and
committees chaired – for example, School Band, Church Choir, Basketball team, Sunday School Teacher, etc.
Year
20
20
20
20
20
20
20
20
20
20
Membership in
groups and
organizations
Offices held and
committees
chaired
Other participation
Honors and
Recognition
VI. Appearance in Support of 4-H
Presentation to other groups or appearances on radio or television related to the 4-H program. Indicate the
name of the group and topic presented.
Year
Topic
Group
Radio
20
20
20
20
20
20
20
20
20
20
VII. Honors and Recognitions Received in 4-H
List the medals, certificates, trips, bonds, jackets, trophies, gifts, grand champions, etc., received.
Approval
We have reviewed this record:
Year
Member
20
20
20
20
20
20
20
20
20
20
Parent or Guardian
Leader
TV