All RockCounty 4-H memberswho have completedthird grade and above are eligible and encouraged to participate in this countywide special recognition program.

The Clover Award Program is designed to recognize 4-H members for their active participation in club and county activities and events.By participating in activities and events, members can earn points towards recognition levels. 4-H members may earn only one (1) Clover Award per 4-H year and may earn the same award more than once. The 4-H year is October 1st to September 30th.

The program has recognition awards each having minimum requirements for completion. The awards include:

Green Clover AwardHave completed 1 year of 4-H15 Points (minimum 8 club level, 3 county, district & state)

Bronze Clover AwardHave completed 1 year of 4-H20 Points (minimum 8 club level, 4 county, district & state)

Silver Clover AwardHave completed 2 years of 4-H25 Points (minimum 10 club level, 5 county, district & state)

Gold Clover AwardHave completed 3 years of 4-H30 Points (minimum 12 club level, 7 county, district & state)

Emerald Clover AwardHave completed 4 years of 4-H40 Points (minimum 14 club level, 9 county, district & state)

Clover Award Applications must be signed by the member,aparent/guardian and a leader (other than a parent/guardian). Clover Award recipients will be notified and awards distributed during the County Awards Program in the fall. DEADLINE: September 16 to the UW-Extension Office.

Any questions, contact the UW-Extension Office at 757-5696.

This form must be completed by the 4-H member.

Please fill in name, club name, and dates. Circle the Clover Award for which you are applying. On the second page of this application, fill in all appropriate information since last submitting your Clover Award. After your application is completed, your Club Leader must verify the information before you send it to the Rock County UW-Extension Office, Attn: 4-H Clover Awards, 51 South Main Street, Janesville, WI53545.

Name: ______Last grade completed: ______

4-H Club: ______Number completed 4-H years (not counting Cloverbud yrs) ______

4-H Year – October 1, 2015to September 30, 2016

Applying for:GreenBronzeSilverGoldEmerald

Member Signature: ______Date: ______

Leader Signature: ______Date: ______

Parent Signature: ______Date: ______

Total 4-H Clover Award Points earned ______+ ______= ______

Club - pg.3 County, District & State – pg. 4 Grand Total

Guidelines:

  1. 4-H members who have completed 3rd grade and above are eligible to apply.
  1. The form must be completed by the 4-H member.
  1. Clover awards are designed for members who have completed a stated number of years. These years are to be considered regular 4-H years. The Cloverbud years will not count. A completed year will include the current year.
  1. Clover Award forms are due to UW-Extension Office by September 16.
  1. Clover Award Applications must be signed by a leader in the club where the points were earned. If there is a change in clubs, the member must have a leader from the previous club sign the form for the points earned during the time in that club.
  1. Required signatures are the member, a parent/guardian and a leader who is not a parent/guardian.
  1. A member is not required to have earned previous levels of recognition in order to earn any other level as long as they meet the requirements. Awards may be earned in any order.
  1. A member is not required to earn a recognition award every year. However, requirements for recognition must be met during the current 4-H year in which the member wants to be recognized. The 4-H year is considered October 1 to September 30.
  1. Only one Clover Award may be received in any given year.
  1. Do not add additional pages.

Club Level Activities/Participation Notes:

  1. Activities and events that involve your club members and do not involve all clubs are considered club level activities and are club points.

County Level Activities/Participation Notes:

  1. 4-H activities listed in the Rock County 4-H Newsletter, Cloverpatch, where all 4-H members can actively participate, are considered county points.
  1. There is only 1 point given for ANY/ALL County wide Project Meetings attended.
  1. County-wide Softball cannot be listed under Club Fundraising/Recreation or Club Other. It should only be listed under County-wide Softball.

UW-Extension provides equal opportunity in programming, including Title IX and ADA requirements. Requests for reasonable accommodations for disabilities or limitations should be made prior to the date of the program or activity for which it is needed. Please make such requests as early as possible by contacting the Rock County UW-Extension Office at 757-5696 so proper arrangements can be made.

Attendance & Record Books
(1 point for each line) / Possible
Points / Actual
Points
4-H Club Meeting Attendance (75-100%)* / 1
Completed 4-H Record Book* / 1
Activity/participation
(maximum of 3 per category) / Subject/What / Possible
Points / Actual
Points
Speech or Demonstration at Project or Club Meeting (Title of Speech or Demonstration) / 1
1
1
Membership & Active Participation on a Committee / 1
1
1
Community Service * / 1
1
1
Fundraising and/or Recreation *
(Club ONLY!) / 1
1
1
Club Leadership (club officer, committee chair, led club pledges, committee report, etc) / 1
1
1
Club Project Meeting Attendance
(75 – 100% of meetings for each project up to 3) / 1
1
1
Club Jr. Leader (list projects) / 1
1
1
Other / 1
1
1

*Activities with an * are required and MUST earn at least 1 point.

Each activity is worth one (1) point. Total points from this page:______

Do not add additional pages.

Member Name: ______

  • Blank spaces may be filled in with special 4-H activities, but not awards.
  • Each activity is worth 1 point.

Points / County / Points / County
After School Programs / Officer Training
Ambassador / Softball (County-wide Organized)
Award forms submitted: Project, Younger Member, Older Member, Resume / Music & Drama Festival
Award Form Interviews-8thgrade & up / Bowling Bonanza
Camp (Cabin or Outpost) and
CampCounselor or CIT / Volleyball
Cloverbud Day CampCounselor / Youth Service Day
Committee member / Other CountyEvents (other than fair related events-maximum of 3 w/examples)
Communication Arts Festival Participant
County Project Meetings (1 pt. total for attending any/all county-wide meetings)
Educational Workshops
Fair Exhibitor or Public Project Display / ------ / -Do not write in this blank -
Fair – AwarenessCenter / Points / District-State-National
FairBuilding Display Set-up / International Exchange
Fair – Cloverbud Judge/Assistant / Leadership Workshop/Camp
Fairgrounds Clean-Up / Space Camp
Fair – Judging Assistant/Jr. Superintendent / State Fair Exhibitor
Fair – Office/Bldg. Watch / State Team (art, drama, photography, showcase singers, tech.)
Fair Pepsi/Bakery Stand / State Project Competition (State Horse Expo, AASD, Dairy Bowl, Dog Show, Plant Science Day, Shooting Sports Meet)
Heatwave / Youth Leadership (Southern District Leadership Team, State Youth Leader Council, etc.)
Jr. Council member-attendance (75%) / Other District-State-National Events (other than fair related events-maximum of 3 w/examples)
Jr. Council officer
Judging Team

Do not add additional pages. Total points from both columns on this page: ______

Member Name: ______

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