Kankakee County 4-H Awards Application
Name________________________________________________________________________________
Address_____________________________________ Club____________________________________
Number of Years in 4-H (Including this Year)_________
Age (as of 9/1 Current 4-H Yr) __________
Area Applying for County Award in _______________________________________________________
I. PROJECT RECORD (Maximum 50 Points)
A. What I learned from this project............................BE SPECIFIC......................... (12 pts) _______
1._____________________________________________________________________________
____________________________________________________________________________
2.____________________________________________________________________________
____________________________________________________________________________
3._____________________________________________________________________________
____________________________________________________________________________
4 .____________________________________________________________________________
____________________________________________________________________________
5. _____________________________________________________________________________
____________________________________________________________________________
6.____________________________________________________________________________ _
____________________________________________________________________________
B. I learned about this project by attending a meeting, event or workshop outside my local club.
Meeting or event attended____________________________________________ (3pts)
_______
C. Additional magazine articles, books, and bulletins I read about the project (1 point each,
give titles of articles)............................................................................................... (4 pts) _______
1._______________________________________________________________________________
2._______________________________________________________________________________
D. Project work done................................................................................................... (20 pts) _______
(Circle section below that applies)
I did the required work in this project (10 pts); OR
I did required work in this project & required work in 2nd project (15 pts); OR
two times required work (15 pts); OR three times required work (20 pts); OR
I did two times required work in this project and the required work in a second project (20 pts):
________________________________________________________(name of second project unit)
E. Assistance to other members in this project................................................................(5 pts) _______
What I did_______________________________________________________________________
F. I exhibited my project on a local project tour or at the local club achievement program
(Circle one).............................................................................................................. (3 pts) _______
G. Rating I received on exhibit at the county 4-H show (A - 3 pts; B - 2 pts; C - 1 pt)
(Circle one that applies). ..........................................................................................
(3 pts ) ______
II. 4-H ACTIVITY RECORD (Maximum 40 pts)
A. My part in the local club program (12 pts) ...........................................................................................
1. Demonstration - Title_____________________________________________
(3 pts) ______
2. Talk - Title______________________________________________________ (3 pts) ______
3. Attended club tour other than tour of members’ projects...................................... (3 pts) ______
_____________________________________________________________________________
4. Special feature on club program ............................................................................ (3 pts) ______
What I did____________________________________________________________________
B. Circle numbers to show what you did................................................... (Maximum 24 pts) ________
Individual/club
County
Regional or State
1. Camping
2
2
2. Careers
2
2
2
3. Citizenship
2
2
2
4. Demonstration
2
2
3
5. Electricity
2
2
2
6. Health
2
2
7. Judging
2
3
3
8. Intercultural
2
2
2
9. Safety
2
2
3
10. Performing Arts
2
2
2
11. Dress Revue
2
3
3
13. Flower Arrangement
2
3
3
– Continued –
14. Foodstand
3
15. Federation
3
16. Fundraising
2
17. Conferences..
3
3
2
3
C. Health......................................................................................................................
(4 pts) _______
1. Physical Examination - date_____________________________________
(2 pts)
2. Dental Examination - date_______________________________________
(2 pts)
III. 4-H LEADERSHIP RECORD Maximum 10 points
A. Responsibilities in my local club..............................................................(maximum 10 pts) ______
1. Committees I served on in my club (1 point each - maximum 4)
_____________________________________________________________________
_____________________________________________________________________
2. I also held the office of __________________________________________ (4 pts)
I was chairman of committee______________________________________ (2 pts)
B. Responsibilities on County/Regional/State Level
1. County - Committees served on____________________________________ (2 pts)
Chairman ______________________________________________________ (1 pt)
Office held_____________________________________________________ (4 pts)
2. Regional - Committees served on___________________________________ (3 pts)
Chairman______________________________________________________ (2 pts)
3. State - Committees served on_____________________________________ (4 pts)
Chairman______________________________________________________ (2 pts)
TOTAL______
(4-H’er must score 75 points or higher to be considered for a County Medal!)
IV. 4-H STORY - Please include a brief account of what 4-H meant to you, and how it has helped you develop as a
person. (May put on this sheet, or attach a sheet if additional space is needed)
APPROVED BY:
_____________________________________________
(Local 4-H Club Leader)
Revised January 25, 2001