MY 4-H RECORD FOR THE ILLINOIS PROJECT HONOR MEMBER AWARD
Name____________________________________
Club________________________________________
Year__________
Number of years I have been a 4-H member (including this year) __________________________________.
(This form may be filled out by 4-H members who are achievement members this year. Report only work done this year. Include
your 4-H project record with this form.)
I.
Maximum
score
Project Record (60 points)
Your
score
I am applying for the Project Honor Award in _________________________________________
(Project unit)
A.
What I learned from this project (2 points for each thing)…………………………………….
12
____
5
____
4
____
20
____
5
____
I exhibited my project on a local club project tour or at the local club achievement
Program (underline one)……………………………………………………………………….
4
____
Rating I received on my exhibit at the County 4-H Show (A= 10 points; B = 7 points;
C = 4 points)……………………………………………………………………………………
10
____
9
____
(If not in your record, attach additional sheet)
B.
C.
D.
I learned more about this project by attending a meeting or event outside my local
Club. Meeting or event attended _______________________________________________
Magazine articles, books, and bulletins I read about the project in addition to my 4-H project
Manual (2 points each and give titles of articles) ……………………………………………..
1. ________________________________________________________________________
2. ________________________________________________________________________
Project work done………………………………………………………………………………
I did the required work in this project unit (10 points); and required work in second project (15
points); OR two times required work (15 points); OR three times required work (20 points); OR
I did two times required work in this project and the required work in a second project unit (20
Points):
Name of second project unit:___________________________________________________
E.
Assistance to other members in this project ……………………………………………….…
What I did__________________________________________________________________
F.
G.
II.
4-H Activity Record (35 points)
A.
My part in the local club program……………………………………………………..………
1. Demonstration, title:________________________________________________ (3 points)
2.
Talk, title: ________________________________________________________(3 points)
3.
Attended club tour other than tour of members’ projects:______________________________(3 points)
(place visited)
Special feature on club program. What I did _____________________________(3 points)
4.
Maximum
score
B.
Circle the numbers to show what you did……………………………………………
Individual or club
Camping…………………….
2
3
2.
Careers………………………
3
3
3.
Citizenship…………………..
3
3
4.
Demonstration……………….
3
5.
Flag Raising………………….
3
6.
Health………………………..
3
3
7.
Judging………………………
3
3
3
8.
Music………………………..
3
3
3
9.
People-to-People……………
3
3
11. Safety……………………….
3
3
12. Work at Fairgrounds Clean-Up.. ….
13. Other……………………….
III.
20
____
6
____
5
____
District or State
1.
10. Public Speaking…………….
C.
County
Your
score
3
3
3
3
3
3
3
3
Health…………………………………………………………………………………
1.
Physical examination date ___________________________
or Health Check date
___________________________
(3 points)
(1 point)
2.
Dental examination date
(2 points)
3.
I kept my Illinois 4-H Health Record this year (1 point) Yes___ No___
___________________________
4-H Leadership Record (5 points)
A.
Responsibilities in my local club……………………………………………………..
1.
Committees I served on in my club (2 points each—maximum 4)
_______________________________________________________________
_______________________________________________________________
2.
I also held the office of________________________________ (3 points)
or was chairman of a committee _________________________ (1 point)
TOTAL
Approved by:____________________________
(Local 4-H Club Leader)