20__4-H Club Charter RenewalApplication

All 4-H Club Charters must be renewed on an annual basis. To apply for renewal of a 4-H club’s charter, the organizational leader of a 4-H club must submit this application, along with the appropriate documentation (listed below) to the local University of Maryland Extension (UME) 4-H Office. Application and supporting documentation should be submitted to the Local UME Office by January 31st. They will review and then forward to the Maryland 4-H Youth Development Program for approval.

Name of 4-H Club: ______

Club Organizational Leader: ______

Address:______

Phone: ______Email: ______

Club #: ______Local UME Office: ______

Maryland 4-H Club Charter Renewal Requirements: / For Extension Office Use Only:
Attachment Included?
  1. The club has a federal EIN tax number. EIN # ______
(Military clubs or afterschool programs in which certification for tax purposes are obtained through other entities must complete the 4-H Club Additional Financial Entity form and attach.) /  Yes  No
2. The club has filed the appropriate 990 or 990 N and a copy of confirmation is attached.
(not required of military clubs or afterschool programs in which certification for tax purposes is obtained through other entities) /  Yes  NoN/A
  1. The club has at least five membersfrom three different families and a list of members is attached.
/  Yes  No
  1. The club has at least two trained UME volunteer leaders and a list of leaders is attached.
/  Yes  No
  1. The club has elected and trained youth officers and a list of officers is attached.(not required of Clover Clubs)
/  Yes  NoN/A
  1. The club has adopted bylaws and a copy is attached.
/  Yes  No
  1. The club has completed the Maryland 4-H Foundation Affiliation Agreement for 4-H Clubs and a copy is attached.
(not required of military clubs or afterschool programs in which certification for tax purposes is obtained through other entities) /  Yes  NoN/A
  1. The club has developed an annual program plan that provides a variety of learning experiences and a copy is attached.
/  Yes  No
  1. The club is in compliance with the Affirmative Action guidelines and a copy of Public Relations Efforts by Clubs Form AA-4H/HE4 is attached.
/  Yes  No
  1. The club plans to hold at least 6 meetings per year.
/  Yes  No
11. The club has completed aFinancialReport and a copy is attached.
(not required of military clubs or afterschool programs in which certification for tax purposes is obtained through other entities) /  Yes  NoN/A
12. The club has completed the 4-H Property Inventory Reportand a copy is attached. /  Yes  No

Our 4-H club understands that the use of the 4-H name and emblem is protected by federal law. I certify that this 4-H club fully meets the requirements to be a 4-H authorized group and respectfully request to renew our official 4-H Charter in order to continue to operate as a legal 4-H entity.

President:______

Name Signature Date

Club Organizational Leader: ______

Name Signature Date

Extension Educator:______

Name Signature Date

For Maryland 4-H Center Use Only:

______This 4-H club is approved for full renewal of its charter for the 4-H year ______

______This 4-H club is temporarily placed on probation for up to three months beginning ______and being reviewed no later than ______due to ______

______

______

______This 4-H club’s charter is revoked as of this date ______due to ______

______

______

______

Official Signature: ______Date Reviewed by 4-H Center: ______

Upon final review of this renewal application by the local Extension Educator, the club should be notified of its status. This application should be filed and kept for a period of three years in the local UME office.

Revised 9/13

University of Maryland Extension programs are open to all persons andwill not discriminate against anyone because of race, age, sex, color, sexual orientation, physical or mental disability, religion, ancestry, or national origin, marital status, genetic information, or political affiliation, or gender identity and expression.

University of Maryland Extension, 4-H Club Charter Renewal Application, page 1/2