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 .