This
form needs to be signed each year by the member, parent
and leader before it is submitted to the county office
for judging. Each must review this document for accuracy
before signing.
| 4-H
Year |
Age
on 1/1 |
Member's
Signature |
Parent's
Signature |
Leader's/Volunteer's
Signature |
Judge's
Signature |
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A.
4-H Projects: List
the 4-H year on the left and list the project(s)
you have completed and included a record for during
that year in the other columns.
| 4-H
Year |
Community
Service Project |
Leadership
Project |
Project
(fill
in name)
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Project
(fill
in name)
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Project
(fill
in name)
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B. Community
Service: Include what you have done to help
your community, groups or individuals (not your
relatives). Include community service done through
groups other than 4-H such as school, church and
other organizations.
| 4-H
Year |
Activity/What
I Did |
Who
I Helped/Results |
4-H/
School/Other |
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| 4-H
Year |
Activity/What
I Did |
Who
I Helped/Results |
4-H/
School/Other |
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C. Leadership: Include
all leadership roles that you have assumed in 4-H
such as offices you have held, leadership roles on
committees and experiences as a junior leader. Include
leadership experiences through groups other than
4-H such as school, church and other organizations.
| 4-H
Year |
Leadership
Experience |
Responsibility/What
I Did |
4-H/School/Other |
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| 4-H
Year |
Leadership
Experience |
Responsibility/What
I Did |
4-H/School/Other |
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D. Workshops/Conferences/Camps
Attended: List those sessions that you have
attended and summarize the most important things
that you learned. Include those done through groups
other than 4-H such as school, church and other
organizations.
| 4-H
Year |
Workshop/Conference/Camp |
What
I Learned |
4-H/
School/Other |
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| 4-H
Year |
Workshop/Conference/Camp |
What
I Learned |
4-H/
School/Other |
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E. Communication
Skills: List the presentations that you have
given including speeches, visual presentations,
illustrated talks, radio programs, T.V. appearances,
video productions, news stories and articles written
by you and any other type of presentations. Include
presentations done through groups other than 4-H
such as school, church and other organizations.
| 4-H
Year |
Type
of Presentation |
#
Times Given |
4-H/School/Other |
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| 4-H
Year |
Type
of Presentation |
#
Times Given |
4-H/School/Other |
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F. Youth
Development; Events and Activities: List activities
that you have participated in and identify the
skills that you have gained through your participation
in these activities. Skills may include communicating,
decision making, coping, managing resources, learning
about yourself and others and job related skills.
Include activities done through groups other than
4-H such as school, church and other organizations.
| 4-H
Year |
Activity/Project |
Skills
Gained |
4-H/School/Other |
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| 4-H
Year |
Activity/Project |
Skills
Gained |
4-H/School/Other |
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G.
Awards and Achievement:List
recognition that you have received. Include awards
received through school, church and other organizations.
Summarize where possible.
| 4-H
Year |
Award
Received |
Achievement/Reason
You Received Award |
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| 4-H
Year |
Award
Received |
Achievement/Reason
You Received Award |
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H.
4-H Story:You
must include your 4-H story, a written narrative
which explains how 4-H has made an impact on your
life or the lives of family or others.
I.Project
Record(s): You must include at least one (maximum
of 5) project records in your record book.
J. Support
Materials: You may include additional materials
to help tell your story. (maximum of 5 pages)
Please
see instructions for
information about how to complete each section,
specific examples and assembly information.
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