4-H PARTICIPATION SUMMARY
Name
Address
Date of Birth
County
Town
Zip
Parents/Guardian
This is a record of your participation in 4-H programs. Summarize your most important accomplishments
and experiences each year. This record will help you and other people evaluate your progress. It is
understood that beginning 4-H’ers may have fewer entries than those with more experience. That’s okay.
This form will help you summarize your participation in 4-H projects, local group involvement, and at
community, county, area, and state levels.
Fill in date, age, grade, and years in 4-H as of September 15th of the current year.
Year
Age
Grade
Years in 4-H
(include this
year)
Name of 4-H Group
Year
Number in
my group
Number of
meetings
held
Number I
attended
COMMUNICATIONS
4-H is sharing ideas and skills you’ve learned with others. List the type of presentation such as a talk,
demonstration, working exhibit, Share-the-Fun, newspaper article, radio, interviews, etc. Use the
following code for level of participation: Local (L), County (C), Area (A), State (S). Under local (L) include
your 4-H group and other community groups. Indicate size as L-12, C-35, S-28.
Year
Type of Presentation
Add extra pages as needed. Use same format as this page.
Topic
Where (Audience)
Indicate size of group
LOCAL 4-H PARTICIPATION
A 4-H experience begins by participating individually of with other 4-H’ers in a club/group. Record here
your participation in local events and activities. Use as many lines for each 4-H year as you need.
Indicate number of people in audience if applicable.
Events/Activities – Include events/activities such as group projects, parties, camps, workshops, tours,
achievement shows, etc.
Year
Events and Activities
Add extra pages as needed. Use same format as this page.
Year
Events and Activities
LOCAL 4-H PARTICIPATION
A 4-H experience begins by participating with other 4-H’ers in a club/group. Record here your participation and
responsibilities. Use as many lines for each 4-H year as you need. Indicate number of people in audience
if applicable.
CITIZENSHIP…………. Include what you do to help others, 4-H community service projects, etc.
LEADERSHIP………… Include offices held, committee responsibilities, other leadership responsibilities, etc.
RECOGNITION……….. Certificates, ribbons, pins, etc. for local level achievements.
Year
Citizenship
Add extra pages as needed. Use same format as this page.
Leadership
Recognition
COUNTY, AREA, STATE PARTICIPATION AND RESPONSIBILITIES
There are many 4-H opportunities for learning and growth beyond the local club/group. Using the following code,
record the level of participation for each item entered: County (C), Area (A), State (S). Indicate number of people
in the audience if applicable. See page 3 for explanation.
Add extra pages as needed. Use same format as this page.
Year
Events and Activities
Year
Add extra pages as needed. Use same format as this page.
Events and Activities
Add extra pages as needed. Use same format as this page.