University of Illinois Extension Peoria County 4-H Member Record (Name) (4-H Club) University of Illinois Extension Peoria County 4-H Member Record This record is a summary of all that 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 used as the basis for award selection. NAME:__________________________________________ BIRTH DATE___________________________________ ADDRESS:__________________________________________________________________________________________ 4-H CLUB:__________________________________________________ YEAR I JOINED 4-H___________________ I. PARTICIPATION IN THE LOCAL 4-H CLUB Begin with your first year in 4-H and list the number of meetings held, meetings you attended; list offices held and the committees you have served on in your club. Year No. meetings held after joining No. attended after joining Club Offices Held Committees served on in the club. (Indicate those chaired with a capital "CH") II. 4-H PROJECTS -- ENROLLMENT, EXHIBITS AND SKILLS LEARNED Begin with your first year in 4-H and list your projects by year. Use one row for each year and one column cluster 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. Refer to the Illinois 4-H Clover for a listing of the proper project name. List exhibit ratings in the Exhibit column. Indicate where the rating was received by using the following abbreviations: (L) = Club; (C) = County/Unit; (S) = State. The exhibit ratings are "A- B- C- Purple Award (PA) - and Superior (SP) at the State Level. Additional inserts of this page are available from your 4-H Leader, add as many as you need. ****** Year Project: Unit and size Skills Learned ******* Exhibit Project: Unit and size Skills Learned ****** Exhibit Project: Year Unit and size Skills Learned ******* Exhibits Project: Unit and size Skills Learned ****** Exhibit III. PARTICIPATION IN 4-H PROGRAMS 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 do on your own or as a club. "County" refers to those activities that you participated in at the County Level. Center refers to activities involving 2 or more Counties from the E. Peoria Center, while Region refers to Regional Activities. State, National and refer to programs offered at those levels. Program Where Done Achievement Program Club County Animal Showmanship County State Camping Club Younger/Older 4-H County Other 4-H related Career Exploration Club County Region/Cluster 4-H Family Event Club County Clothing Revue County State Community Service Club County Demonstration and Talks Club County State 4-H Conference State 4-H Federation County BK4K Show County Judging except livestock (specify in box) County Regional/Center State National Judging Livestock and or Meats (specify in box) County Region/Center State National International Activity Club County State/National/Int. 20_ 20__ Radio Program County 4-H Corner County National 4-H Week Club County Public Presentations County State 4-H Promotion Club County Miscellaneous 4-H Event (specify in box) Club County Region/Center Safety Club/County Health Club/County Window Display County State Workshops and Clinics or Conferences not included above (specify in box) Club County Region/Center State National Project Tour Club Business Tour Club Help with Fair: 4-H food-stand, fair-tour, fair setup County Judges' Assistant County Tractor Driving Contest County Regional State National Cultural Exchange County Region State Share The Fun Skit Contest County Barnyard Olympics County 4-H Missions in Space Trip State National Master Showmanship Contest County State Region/Center List other programs and workshops not listed above; please indicate the year(s) in which you participated: IV. 4-H LEADERSHIP List your specific responsibilities and in (parenthesis) indicate the number of members assisted, along with the appropriate letter indicating: (L) club; (C) county; (R) Regional/center, and (S) State. Example: Taught project workshop on visual arts (15)(C). DO NOT indicate club offices or committees. Year 20__ Activity/Leadership responsibility V. APPEARANCES IN SUPPORT OF 4-H Please list the occasions when you have appeared publicly in support of 4-H. List the year, topic and name of group addressed if the appearance was a speaking engagement. If the media were used, please indicate the station or newspaper. Year Topic Group Addressed Newspaper Radio T.V. 20__ VI. NON-EXTENSION OR 4-H RELATED ACTIVITIES Summarize what you have done in your school, community and church activities. In the columns with Activities, tell what you did in the groups to which you belong. In the column "leadership roles," indicate any offices held or committees chaired. Year 20__ School Activities Church/Community Activities Leadership Roles VII. HONORS AND RECOGNITION In the space below, please list the honors and awards you have received, in both 4-H and other areas. Please do not include 4-H show exhibit ratings. Include such items as medals, certificates, bonds, trips, gifts or Grand Champions that you have received. 4-H Related honors Non 4-H Related Honors VIII. MISCELLANEOUS This category is designed for all items that you feel are important to your 4-H experience and did not fit into another category. Use this space to tell about the meaningful events or lessons that you experienced during your 4-H career. IX. APPROVAL We have reviewed this record. Year Member's Signature Parent/Guardian 4-H Leader 20__ University of Illinois Extension Peoria County, 4810 N Sheridan Rd, Peoria, IL 61614 Phone: 309-685-3140 fax: 309-685-3397 Web: www.extension.uiuc.edu/peoria Virginia Kuo, 4-H youth development educator, vkuo@uiuc.edu Cathy Ludolph, 4-H program assistant, ludolph@uiuc.edu University of Illinois at Urbana-Champaign College of Agricultural, Consumer and Environmental Sciences United States Department of Agriculture Local Extension Councils Cooperating University of Illinois Extension provides equal opportunities in programs and employment .