Madison/St. Clair
4-H County Award Application
For the 2010-2011 4-H Year ONLY!
(Due Date: August 31, 2011)
GENERAL INFORMATION
NAME __________________________________________________________________
ADDRESS __________________________________ CITY ___________ STATE _____
CLUB __________________________________ NUMBER OF YEARS IN 4-H _______
BIRTHDATE _________________ YEAR IN SCHOOL ______________
CHECK AGE CATEGORY age 8-11 ____ age 12-15 ____ age 16-19 ____
Project Area
I am applying for an award in the following area: CHOOSE ONE. (If you would like to report
on more than one project, use a new application for each project.)
__Community Development & Global Awareness (citizenship, intercultural)
__Engineering and Technology (Aerospace, bicycle, computer science, electricity,
geospatial(GIS/GPS), robotics, safety (mechanical-oriented safety), small engines,
tractor, woodworking)
__Environment & Natural Resources (camping, outdoor living, conservation, entomology,
forestry, geology, natural resources and sports fishing)
__Personal Development (communication, photography, visual arts, leadership, theater
arts)
__Food, Nutrition & Health (all food and nutrition and health)
__Plants & Soils (plant & soil science, crops, horticulture, soils)
__Home & Family (child development, intergenerational, clothing & textiles, home furnishings,
consumer education)
__Animal Science (beef, cat, dairy, dog, goat, horse, poultry, rabbit, sheep, small pets,
swine, vet science)
1. List the project(s) you have completed in the project area indicated above.
(5pt per project)
2. List the county ratings you received during the 4-H show on the exhibits in your project
area. (5pt – blue, 3pt – red, 1pt – white)
3. List the exhibits in your project area that were selected for State Fair or Best of Show.
(5pt – State Fair selection, 5pt – Best of Show)
4. If your exhibit was judged at the State Fair, list the State Fair rating.
(5pt – Superior, 3pt – Award of Excellence)
5. Give the title of the talk or demonstration you presented to your club this year in your
project area. (5pt – demonstration, 3pt – talk)
6. List any workshops, tours, and/or activities related to your project area.
(1pt – 1-3 activities, 3pt – 4-6 activities, 5pt – 7 or more activities)
7. What knowledge and skills did you learn from the project(s) in your project area this
year? (1pt – 1-3 skills, 3pt – 4-6 skills, 5pt – 7 or more skills)
Leadership Area
8. What percentage of your 4-H club meetings did you attend?
100 % _____ (5pt)
75-99%_____ (3pt)
50-74%_____ (1pt)
0-49% _____ (0pt)
9. List any offices you have held in your club this year. (5pt – president, vice president,
secretary, treasurer; 3pt – reporter, historian, refreshment chair, other)
10. List the 4-H committees on which you have served this year. (Include your club, county,
region, state and national committees). Indicate if you were the chairman of the
committee. (1pt – per committee, 2pt – committee chair)
11. List any community service activities in which you were involved this year AND the
number of hours spent in that activity. Do not include fund raising activities.
(Per community service activity; 1pt – 1-5 hours, 2pt – 6-10 hours, 3pt – 11 or more
hours)
12. List any 4-H club activities and 4-H fundraisers you were involved this year.
(1pt – 1-3 activities, 3pt – 4-6 activities, 5pt – 7 or more activities)
13. List any other organizations and clubs (school or community) to which you belong this
year. Indicate if you held an office. (1pt – per organization, 2pt – per office held)
My 4-H Story
(50pt)
Your story is an important part of your award application. It gives you the opportunity to
highlight what you feel is your most important accomplishments during the 4-H year. Your story should
focus on the award area you are applying in. This story can tell about the things you have made in the
project area and any experiments you may have tried. Tell about your successes in the project area. Did
you have any failures? You can tell about how 4-H has boosted our confidence and attitude in life. Has
your 4-H participation affected your career choice? If 4-H has helped you become a better leader and
citizen talk about it here. Write an age appropriate story.
Make your 4-H story personable. The reader should be able to describe YOU when they are
finished. It may be a “straight facts” story, or may demonstrate some of your creativity, as long as the
facts are correct and your point gets across. If you wish to include information about a special
accomplishment, include those details in your 4-H story along with what it took for you to reach that
successful moment (skills learned, family time together, challenges overcome, etc.)
Write or type your 4-H story on a separate sheet of paper.
Signature _____________________________________________ Date __________________
Leader’s Signature ______________________________________Date___________________
Parent’s Signature_______________________________________Date___________________