Appanoose County 4-H
PERMANENT RECORD
Name
Parent/Guardian Name
Address
Date of Birth
Club
PURPOSE OF WORK
To help young people in the development of Character, Leadership, and Citizenship.
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MEMBER PARTICIPATION RECOGNITION SYSTEM
Helps you carry out the purpose of 4-H in your own life,
Helps you see the many different things you can do in the 4-H program,
Gives you a method for summarizing your own 4-H achievements,
Encourages you to keep accurate and complete records.
PURPOSE OF PERMANENT RECORD
The purpose of the Permanent Record is to measure a 4-H member’s involvement in club
and community activities. The Permanent Record is a 4-H member’s “4-H Life History”
and in the future will serve as a resource for 4-H trips and awards, scholarships, school
and job applications.
LOCAL 4-H MEETINGS
Grade
04
0
5
06 07 08 09 10 11 12
Number of club meetings held this year
Number of meetings I attended this year
Year (i.e., 2002, 2003, etc.)
1
OTHER COUNTY, STATE & NATIONAL EVENTS
Grade
04 05 06
07 08 09 10 11 12
Winter Camp
Intermediate Trip
Appanoose County Fair
Officer Training
Iowa State Fair
Citizenship Washington Focus
State 4-H Congress
State 4-H Conference
State 4-H Council
National 4-H Council
Other:
2
Year
ANNUAL PARTICIPATION SUMMARY
4-H PROJECT SUMMARY
LIST PROJECTS
COMPLETED
LIVESTOCK
EAR TAG # OR
ID #
NUMBER OF PROJECT
MEETINGS ATTENDED
WHERE EXHIBITED
C = CLUB
F = COUNTY FAIR
S = STATE
RIBBON
PROJECTS EXHIBITED
Number of exhibits completed this year
Number of exhibits shown this year
3
Year
4-H COMMUNICATION ACTIVITIES
Examples: Public Speaking, Demonstrations, Promotional Talks, News Stories, Radio or TV appearances.
PROJECT OR ACTIVITY
SUBJECT OR TITLE
NUMBER OF TIMES GIVEN
WHERE PRESENTED
/GROUP SIZE
Year
Demo/Talk to 4-H Group this year
Demo/talk to non 4-H group this year
Radio/TV/News Story this year
TOTAL THIS YEAR
4
Year
COMMUNITY SERVICE
Report only when you participate with other members of your club in a group-planned activity to
education or benefit your community.
Describe Activity
How were you involved
TOTAL THIS YEAR
5
Year
4-H OFFICES AND COMMITTEE ASSIGNMENTS
4-H CLUB OFFICES
 List the offices you held in your club (President, Vice President, Secretary, etc.)
Name of office
CLUB COMMITTEES
 List your committee assignments. Examples: Hayride committee, refreshment committee,
hosting club meetings, providing refreshments for meetings.
Name of Committee
6
Year
YOUTH LEADERSHIP
Responsibilities for 4-H group, encouraging leadership development in younger members, helping
members develop skills, planning a series of meetings, etc. Example: Youth Council member, 4-H
Adult Committee Representative, Camp Counselor, Herdsmanship Judging at Fair, Show
Announcer at Fair, Leader Recognition Banquet planning, etc.
Project or
Activity
# of events you
planned
Number of Youth you
Assisted
List your Specific Leadership
Responsibilities
TOTAL THIS YEAR
7
Year
OTHER 4-H PARTICIPATION
Include all 4-H participation. Examples: Hay rides, fund raisers, roller skating parties,
pizza parties, etc.
Event
Contributions
TOTAL THIS YEAR
8
Year
NON 4-H PARTICIPATION
Report participation, special leadership roles and recognition (Example: church choir,
scouts, FFA, sports, school newspaper, etc.)
Event
Contributions
9