Coles County 4-H Member Record
This record is a summary of all activities, honors, etc. you have done while in 4-H. It will be used in evaluating
your progress and planning future work. It will also be the basis for award selection.
Read all instructions at the beginning of each section carefully. One line or column is provided for each year.
Please use pencil or type to fill in.
Name
Birth date
Address
Route or Street
Town/Zip
4-H Club
Year Joined 4-H
I.
Participation in Local 4-H Club
Number of Meetings
Year
Total
Held after
joining
Attended after
joining
Club offices held
Club committees worked on.
(Indicate committee chair with
“CH”). (Do not include
community service.)
Put totals in pencil.
II. 4-H Projects — Enrollment, Exhibits and Skills Learned
Year
Project
Activities in project area
Example: Foods
Workshops or events attended or presented:
Tricks for Treats
1999/2
000
Skills learned:
6 recipes
2 meals prepared
2 relish trays for holidays
Project exhibited:
Club project tour
yes
County fair
√ yes
State fair
√ yes
√ no
no
no
Number of people reached or served ________
Project area club talk/demo: √
yes
no
Let’s Start Cooking
2000/0
1
Recognition in project area: Blue ribbon – county
fair, superior at state fair
Workshops attended/Leadership:
Skills learned:
10 recipes
5 meals planned
snacks for 8 person slumber party
2 experiments
Project exhibited:
Club project tour
County fair
State fair
yes
√ yes
yes
√ no
no
√ no
Number of people reached or served _______
Project area club talk/demo:
√ yes
no
Recognition in project area: blue ribbon, reserve
champion – county fair
Workshops attended/Leadership:
Skills learned:
Project exhibited:
Club project tour
County fair
State fair
yes
yes
yes
no
no
no
Number of people reached or served ________
Project area club talk/demo:
yes
no
Recognition in project area:
II. 4-H Projects — Enrollment, Exhibits and Skills Learned
Year
Projects
Activities in project area
Project:
____________________________________
Workshops attended/Leadership:
Project exhibited:
Club project tour
County fair
State fair
Skills learned:
yes
yes
yes
no
no
no
Number of people reached or served ________
Recognition in project area:
Project area club talk/demo:
yes
no
Project:
___________________________________
Workshops attended/Leadership:
Project exhibited:
Club project tour
County fair
State fair
Skills learned:
yes
yes
yes
no
no
no
Number of people reached or served ________
Recognition in project area:
Project area club talk/demo:
yes
no
Project:
___________________________________
Workshops attended/Leadership:
Project exhibited:
Club project tour
County fair
State fair
Skills learned:
yes
yes
yes
no
no
no
Number of people reached or served ________
Recognition in project area:
Project area club talk/demo:
yes
no
III. Participation in 4-H Programs
Put month and year of program/activity. Indicate level with appropriate letter: club (L); county (C), regional (R);
state (S).
Program
Achievement
program
Action Board
Camps
(4-H Camp, Space
Camp, Fishing Camp,
etc.)
Clinics
(Livestock, Sewing,
Horse, Photography,
etc.)
Clothing Revue
Conferences
(Jr. Leadership,
E.D.G.E., CWF,
Legislative Connection,
Dairy, etc.)
4-H Equine
Challenge
4-H Week Activity
(Cookie Baking, 4-H
promotion, etc.)
20__
20___
20___
20___
20___
20___
20___
20___
20___
20___
III. Participation in 4-H Programs – continued
Program
20___
20___
20___
20___
20___
20___
Helped with:
Pork Chop BBQ
4-H Show Clean Up
4-H Show Pop Stand
Jr. Superintendent
Judging
(Livestock, Horse,
Meats, Poultry, Dairy,
Forestry, Horticulture,
Wildlife, etc.)
Officer Training
Youth Exchange
Other Programs
Not Listed
# Of People
Reached or
Served
IV. 4-H Leadership
20___
20___
20___
20___
Indicate major responsibilities with appropriate letter: club (L); county (C); multi-county (M); regional
(R); state (S). (Such as jr. leader, project leader, jr. superintendent, etc)
Year
Offices
Committees worked
on
Indicate committee
chaired with (CH)
2002
List specific responsibilities
Club (L); county (C); multi-county (M); regional (R); state
(S)
Example: Taught project workshop on visual arts.
V.
4-H Awards
(Do not put awards already listed in Section II.)
Year Award(s)
1999/
Example: Key Club, I Dare You
2000
# Reached
or Served
15
VI.
4-H Community Service/Citizenship
Indicate major responsibilities with appropriate letter: club (L); county (C); multi-county (M); regional (R);
state (S).
Year
2002
Community
Service/Citizenship
Activity
Indicate committee
chaired with (CH)
Food Basket for Homeless
Shelter (CH)
List specific responsibilities
Club (L); county (C); multi-county (M); regional (R); state (S)
Example: Collected donations for food basket, delivered food
basket to homeless shelter
# Reached
or Served
5
VII.
Public Presentations or Demonstrations
(Do not put talks/demonstrations already listed in Section II.)
Date
Club, County
or State
Talk Title
Demonstration Title
# Reached
or Served
VII. Promotions and Appearances in Support of 4-H
(Interviews or articles written by you.)
Year
Topic
Group Addressed
Paper
Radio
TV
VIII. Non-4-H Related Activities, Workshops and Shows
Date
2002
Event
Example: attended horse workshop and show in Bloomington
IX.
Non-4-H Related Community Service
Indicate committees chaired (CH)
Year
Group/Organizations
Offices held and
committees chaired
Other participation
Honors and
recognitions
Example
2002
Boy Scouts
Car wash, CH
Awards Committee
Badge
X.
Miscellaneous
This section is for items you feel are important; but did not fit into another section.
Year
XI. 4-H Story
This story needs to be one paragraph in length. A new paragraph will be written for each year you are
involved in the 4-H program. The story should consist of personal feelings of your 4-H year. Be sure to
include success, failures, learning experiences, a humorous experience or any experience that is not
already listed in your records.
Year
XII. Approval
We have reviewed this record:
Year
Member
Parent/Guardian
Leader
Implemented 04-05
Revised 4/05