GREENECOUNTY 4-H PROJECT AWARD APPLICATION FORM

(Please fill out a separate form for each project area for which you are applying.)

PROJECT AREA I AM APPLYING FOR: ______

This page along with your Record Book must be to your 4-H leader by: August 31

4-H Leaders must turn in Record Books and this application by 4:30pm on September 1

Personal Information:

Name ______Club ______

Address ______City ______

School Grade Completed as of last May ______

4-H Project Award Checklist

4-H member needs to fill out the chart below with the required information for the award area for which they are applying.

Requirements for Junior, Intermediate and Senior Awards are on the back of this sheet.

Leaders need to verify that the information is correct before turning the application into the Extension office.

*All items must be successfully completed for the 4-H member to receive the project award.

(Leader Verification)

**If more space is need, please attach a separate sheet. ** /
JUNIOR
/ INTERM. / SENIOR
Attended 54-H club meetings. Attended ______out of ______meetings.
Participated in 4-H Club activity(ies). Please Attach List On A Separate Sheet
Participated in County 4-H activity(ies). Please Attach List On A Separate Sheet
Completed a “Yearly 4-H Summary”. ___ Yes ___ No
“Project Records”/4-H Story: Enrolled in ____ years in project area.
Project Goal(s) Identified: ___ Yes ___ No
Income and Expenses Identified: ___ Yes ___ No
Learning Identified: ___ Yes ___ No
Completed 4-H Citizenship activity(ies). Please Attach List On A Separate Sheet
Completed 4-H Leadership activity(ies). Please Attach List On A Separate Sheet
Completed 4-H Communication activity(ies). Please Attach List On A Separate Sheet

4-H’er Signature:______Date: ______

Parent/Gardian Signature: ______Date: ______

I, ______, club leader, verify that the above requirements are met and recommend this 4-H’er be considered for the above project award.

June 2016 KH