YOUNG MEMBER
4-H AWARD APPLICATION
Ages 8-11 (as of Sept. 1, 2009)
HENDERSON COUNTY
 This application covers ALL your 4-H years.
 Answer the questions that follow. You may use extra paper for completing Sections 1, 2, and 3.
 Write one 4-H story for Section 4. Do not write a story for each project you enrolled in. The 4-H story is to
be no longer than 1 page.
 Signatures are needed at the bottom of this page.
Name_____________________________________________________________
First
Middle
Last
Address ____________________________________
City _____________________________
State __________
Zip code __________
Age as of September 1, 2009: ___________
Name of 4-H Club _________________________________________
STATEMENT BY MEMBER
I personally have prepared this application and certify that it accurately reflects my work.
Date _______________ 20_____
Signature of 4-H Member ________________________________________
APPROVAL OF THIS REPORT
We have reviewed this application and believe it to be correct:
Date __________________, 20_____. Signed _______________________________________________
Parent/Guardian
Date __________________, 20_____. Signed _______________________________________________
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Local 4-H Leader
SECTION 1 - EXPERIENCES IN YOUR 4-H PROJECTS
List projects taken each year. Use numbers to show size, growth and financial information (if applies).
Example: 2008 - Made 25 recipes, prepared 3 meals and 2 experiments
2009 - Made 35 recipes, prepared 5 meals
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Learning Experiences - What 4-H learning experiences have you participated in at the club, county,
regional or state level?
(exhibits, radio/television appearances, newspaper articles written, tours, workshops, camps, judging events,
field trips, etc)
Club__________________________________________________________________________________
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County________________________________________________________________________________
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Regional/State__________________________________________________________________________
______________________________________________________________________________________
List all talks and demonstrations given.
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List three or more things you have learned from 4-H
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__________________________________________________________________
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(over)
SECTION 2 - 4-H LEADERSHIP EXPERIENCES
List your leadership experiences.
__________________________________________________________________
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SECTION 3 - CITIZENSHIP/COMMUNITY SERVICE
List activities you have participated in relating to citizenship and community service.
__________________________________________________________________
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SECTION 4 - MY 4-H STORY
No more than one page. Do not write a story for each project. Attach it to the Award Application.
A well-written 4-H Story adds warmth and depth to the information already provided. It should not be
a re-listing of what has already been provided in other parts of the application.
What have you learned in 4-H that can be applied to your life and the lives of your family? How has
your participation in 4-H contributed to your concern for others, and influenced you in school, your
use of leisure time and your career plans?
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You may also want to include some of the following information in your 4-H Story:
- How 4-H helped you learn things you didn’t know before.
- Things you tried successfully or unsuccessfully.
- Unusual situations you encountered.
- How 4-H helped you become a better leader and citizen.
- How 4-H increased your interest and participation in community affairs
- What you learned about team efforts.
- How 4-H helped you feel good about yourself.
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