2011
GALLATIN COUNTY 4-H COUNTY AWARD APPLICATION
NAME_______________________ CLUB ______________________ AGE ________
AWARD APPLIED FOR (CIRCLE ONE):
COUNTY MEDAL
BLUE AWARD
AWARD AREA APPLIED FOR (CIRCLE ONE FROM BELOW) SEE PAGE 52 OF CLOVER
Achievement
Environment & Natural Resources
Animal Science
Food, Nutrition, & Health
Community Involvement & Global Awareness
Home & Family
Dairy
Personal Development
Engineering & Technology
Plants & Soils
PLEASE ATTACH THE APPROPRIATE ILLINOIS 4-H PROJECT FORMS AND ACTIVITY SHEETS.
Possible
Mine
A., This year I have met the Performance Standards (as outlined in the Clover)
for my age group.
15
____
B. What I learned in this area. (more than one year's work)
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1. ______________________________________________________ (3 points)
2. ______________________________________________________ (3 points)
3. ______________________________________________________ (3 points)
4. ______________________________________________________ (3 points)
5. ______________________________________________________ (3 points)
____
C. I attended the following meetings, workshops or events related to this
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award area. 5 points for each different meeting or event attended.
Name of event
Month &- Year Attended
1. ______________________________________________________ (5 points)
2. ______________________________________________________ (5 points)
3. ______________________________________________________ (5 points)
4. ______________________________________________________ (5 points)
5. ______________________________________________________ (5 points)
_____
D. Magazine articles, books, or bulletins I have read this year in addition to
my project books. List title of article, author & publication where appropriate or
the title & author if it was a book.
1. ______________________________________________________ (2 points)
2. ______________________________________________________ (2 points)
4
_____
E. I participated in the County Public Presentations Contest this year
in this award/project area.
8
_____
F. I have exhibited & received 'A' on the following projects in this awards area.
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(May reflect more than one year's project work. (I point for each)
Project ______________________ Year _____ Project ______________________ Year _____
Project ______________________ Year _____ Project ______________________ Year _____
Project ______________________ Year _____ Project ______________________ Year _____
Project ______________________ Year _____ Project ______________________ Year _____
_____
G. Received the following ratings on projects related to this award area.
2
(May reflect more than one year's project work) List Project(s) & year(s) received.
1. State Fair or State Fair Alternate
_____________________________ (1 point)
2. County Champion if not a State Fair class
_____________________________ (1 point)
H. Committees I served on this year in my club.
1. ___________________________________ (2 points)
2. ___________________________________ (2 points)
I. I have held the following offices in my club.
May include any elected office from this year or from previous years.
1. ___________________________________ (1 point)
2. ___________________________________ (1 point)
J. This year I am enrolled as a Junior Leader in my club.
_____
4
_____
2
_____
5
_____
K. This year I helped promote 4-H in the following ways:
May be Public Service announcements, news articles, volunteer service to County 4-H program or other 4-H
promotion events.
1. ___________________________________ (2 points)
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_____
2. ___________________________________ (2 points)
3. ___________________________________ (2 points)
L. This year I participated in the following COMMUNITY SERVICE ACTIVITIES
Examples are Flood relief, jump rope for heart, fund raising for charity, Leukemia Skate-a-thon, Relay for Life,
etc.
1. ___________________________________ (2 points)
6
_____
2. ___________________________________ (2 points)
3. ___________________________________ (2 points)
TOTAL
STATEMENT BY MEMBER
_____
I have personally prepared this application and certify that it accurately reflects my work.
Date _________ Signature of 4-H Member _________________________________________________
APPROVAL OF THIS RFPORT
I have reviewed this application and believe it to be correct.
Date _________ Signature of 4-H Leader___________________________________________________
YOU MAY NOT USE THE SAME EVENT IN MORE THAN ONE SPOT. EACH EVENT WILL ONLY COUNT ONE TIME.
CLUB LEADER MUST SIGN
INDEPENDENT MEMBERS – PARENT CAN SIGN AS LEADER