Missouri 4-H Century Family
The Missouri 4-H Century Family program recognizes 4-H families with a long, sustained involvement
in the 4-H program. Missouri 4-H Families with a combined 100 years or more of membership and/or
volunteer service in 4-H will be recognized.
Applications can be submitted at any time.
The program is coordinated by the Missouri 4-H Foundation and the Missouri 4-H Center for Youth
Development.
Recognition will take place on the county level.
4-H Years that are Applicable:

Direct-line family members are considered. Aunts and uncles, cousins, etc. may not be considered. Stepparents, stepchildren or
adopted children may be included.

Supporting documentation is not necessary.

Paid staff years (extension or other) do not qualify.

In some instances, local Extension Homemakers or Farm Bureau members committed significant time and energy to establishing
and leading local 4-H Clubs. Years of service to 4-H in those capacities are applicable.

Volunteer years devoted to 4-H Club work on the county, regional or state
levels are applicable.

4-H membership or leadership in Missouri or other states can be included.

Years as an enrolled Clover Kid or Clover Bud may be counted.
Submit completed application to the local
University of Missouri Extension Center
or to:
Missouri 4-H Foundation
1110 S. College Avenue
Columbia MO 65211
Phone: 573/882-2680
Email: 4hfoundation@missouri.edu
Rev 6/14
Example: Relationship Chart
Section 1
Generation One
(most recent)
Start with the most recent family members involved with the 4-H program as “generation 1”. Show only family members who are or
were 4-H members or volunteers. List additional details for each individual beginning in Section 2.
Snappy Johnson
Jim Johnson
Sally Johnson
Grandpa Jake
Granny Bette
Gerald Smith
Kathy Smith
Susie Caleb Johnson
Grandparents
Parents
Rev 6/14
Example Application
Missouri 4-H Century Family
Section 2
Name & Current Address
Member
Years
Volunteer
Years
Mt Zion 4-H
1989-2000
10 yrs
2
Mt Zion 4-H
1995-2001
Total
Member &
Volunteer
Years
12
Jim Johnson
7711 Co Rd 426
Hannibal MO 63401
Sally Johnson
7711 Co Rd 426
Hannibal MO 63401
Snappy Johnson
7711 Co Rd 426
Hannibal MO 63401
Susie Johnson
7711 Co Rd 426
Hannibal MO 63401
1965
Ravalli, MT
Summerdale
1966-75
11 yrs
1965
Marion, MO
Mt Zion 4-H
1994-2001
Grandpa Jake
1341 Summerdale
Corvallis MT 59828
Granny Bette
1341 Summerdale
Corvallis MT 59828
Gerald Smith
(deceased)
1943
Ravalli, MT
Darby Pioneers
1936-1947
11 yrs
1947-72
24 yrs
35
1944
Ravalli, MT
Summerdale
1937-1948
11 yrs
1967-1986
18 yrs
29
Ravalli, MT
Darby Pioneers
1937-1942
4
Ravalli, MT
Darby Pioneers
1936-1946
10
Grandparents
Children
1995
Club
Parents
(if available or
applicable)
Year
County, State
of
Birth
1996 Marion, MO
Kathy Smith
(deceased)
Marion, MO
(To be eligible, must equal or exceed 100 years)
6
1999-2001
2 yrs
Marion MO
13
7
Grand total:
116
Rev 6/14
Relationship Chart
Section 1
Generation One
Start with the most recent family members involved with the 4-H program as “generation 1”. Show additional details for each individual
beginning in Section 2.
Grandparents
Parents
Rev 6/14
Missouri Century 4-H Family
Section 2
Family Name:
Please designate the Missouri County through which you would like to be recognized:
Name & Current Address
County, State
Club
Member
Years
Volunteer
Years
Total
Member &
Volunteer
Years
Children – Generation #1
(if available or
applicable)
Year of
Birth
Attach additional sheets wherever necessary.
Additional forms available at http://4h.missouri.edu/foundation
-
continued -
Rev 6/14
Name & Current Address
County, State
Club
Member
Years
Volunteer
Years
Total
Member &
Volunteer
Years
Grandparents
Parents
(if available or
applicable)
Year of
Birth
- continued Rev 6/14
Name & Current Address
County, State
Club
Member
Years
Volunteer
Years
Total
Member &
Volunteer
Years
Great Grandparents
(if available or
applicable)
Year of
Birth
(To be eligible, must equal or exceed 100 years)
Grand total:
Name and address of person submitting the application:
Home Phone
______
Date Submitted _________________________
Rev 6/14