Name Club
Years in 4-H (do not include years as a Clover Kid)
Grade
All requirements need to be checked off:
Year
____ 1. Attend at least two-thirds of all local 4-H club meetings and provide good excuses for any missed meetings.
_____ 2. Give at least one educational presentation to your club. This can also include leading an educational activity. This may be done at club meetings, workshops or tours.
_____ 3. Enroll and carry to completion at least one project. A project is complete when you’ve set project goals, completed the activity and evaluated it.
_____ 4. Set at least one goal for your own personal management (such as coming to meetings on time, learning to speak in front of a group, working with others, etc.)
_____ 5. Keep a record of your goals, experiences and accomplishments by using your
4-H recordkeeping materials. Turn in your recordkeeping information to your leader by September 15.
_____ 6. 4-H Participation
Juniors complete at least THREE of the following. Intermediates and Seniors complete FOUR or more.
_____ Hold an office at one of the following levels: ____ club ____ county
_____ Participate in a community service activity and list it here
_____ Participate in local achievement show or local club tour
_____ Exhibit one or more projects at the county fair
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_____ Attend State Fair (either as exhibitor or visitor)
_____ Attend Club Officer’s Training
_____ Attend 4H Award’s Program
_____ Attend Winter Carnival
_____ Attend State Youth Conference or Animal Science Round-Up
____ Other: Please list:
I BELIEVE I HAVE SATISFACTORILY COMPLETED THE ABOVE REQUIREEMENTS
AS CHECKED.
DATE
MEMBER SIGNATURE
_____ Participate in the 4-H Communication Program beyond the local club level: Educational Presentation, Working Exhibit, Share the Fun,
Extemporaneous Speaking
_____ Serve as host or hostess at a club meeting
_____ Serve on at least one committee (i.e. telephone committee, recreation)
_____ Attend a 4-H Camp (county or state)
_____ Attend a project meeting/training (i.e. dog project, swine project, horse project)
DATE
DATE
LEADER SIGNATURE (only sign if complete)
PARENT SIGNATURE
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