CecilCounty4-H

2017 President’s4-H VolunteerServiceAwardRecord

Completethisformtotrackyourservice-learninghours.CommunityServicereferstoeffortstohelpothersandtoimproveyourcommunity.Youcan beparticipatingonbehalfofacommunity,religious,and/oryouthorganization.Itcanbeanindividualeffortorwithagroupsuchasaschool-basedservicelearningproject.Thiscanincludeclubprojects,communityevents,fairactivities,and4-HCampservices.Examplesofcommunityserviceincludesingingatnursinghomes,gatheringsuppliesforthetroops,volunteeringatalocalhospital,purchasingitemsforthoseinneed,andanything thatbenefitsthecommunityforthosewhoarenotasfortunate.Thingsthatwouldnotcountarefundraisers,unlessalltheproceedsaregiventoanorganizationliketheAmericanCancerSocietyorthelocalhomelessshelterthathelpsothers,andneitheryounoryour4-Hclubarebenefitingfromtheservice.Asareminder,teachingyouthcitizenshipisoneofthecoregoalsofthe4-Hprogram,soeachclubshouldbedoingat leasttwocommunityserviceactivitiesannually.Hoursmustbecompletedduringthe2017calendaryear.

ReturnthiscompletedformtotheExtensionOfficebyJanuary31,2018.

University of Maryland Extension programs are open to all and will 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.

Date / CommunityServiceActivity / Explanation of CommunityServiceAspect of Activity / Hours

Continues on Other Side

Date / CommunityServiceActivity / Explanation of CommunityServiceAspect of Activity / Hours

TotalHoursServed:

4-H Age

/

Green

/

Bronze

/

Silver

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Gold

Kids 8-10

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1-25 Hours

/

26-49 Hours

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50-74 Hours

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75 or More Hours

Teens 11-15

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10-49 Hours

/

50-74 Hours

/

75-99 Hours

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100 or More Hours

Young Adults 16-18

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20-99 Hours

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100-174 Hours

/

175-249 Hours

/

250 or More Hours

I verify that the above information is accurate

4-H MemberSignatureDateofSubmission

Address

County/CountryE-mailAddressBirth DateAge

ParentorGuardianSignature

University of Maryland Extension programs are open to all and will 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.

Revised10/2016