Rock

County

4-H

Participation Record

Revised 2012 Year

Name

Parent/Guardian

Club Age

Years in 4-H Grade

List Projects Enrolled in This Year

Number of Years Number of Years

Project In Project Project In Project

Goals

  • Personal Goals (Goals that will make me a better person)

1. 

2. 

3. 

4. 

Picture of You

(Add additional pages of pictures

if you would like)

Picture of You

(Add additional pages of pictures

if you would like)

  • Responsibilities or Activities (outside of 4-H)

Family

School

Church

Community


4-H Projects

  • Project Meetings You Attended:

Project Level (club, county, cluster, state) What I learned and did

  • Demonstration/Project Talks - List demonstrations/project talks or other ways I have

shared my project:

Project Area What group & how many watched me Topic/Title and Description

  • Project Recognition - Awards or recognition I have received this year for your projects (County & State Fair, Round-Up Awards, Medals, Trips, Scholarships, etc.) Add another page if necessary.

Project Area Item/Title Name of Event Placing Ribbon

  • Project Leader/Helper Yes No (If yes, fill out information below)

Project Area What I did for other club members? How I did it?


4-H Participation

  • Club Meetings - X the months that you attended your 4-H club meeting

Oct. Nov. Dec. Jan. Feb. March April May June July Aug. Sept.

  • Club Meetings

Office held in my club

Served as a youth leader Yes No If yes, what did you do as a leader?

  • Club Committees

Committees Served On My Responsibility

Example: Christmas Party Planning Example: Brought Decorations and games

  • Community Pride

Project My Responsibility

4-H Activities and Learning Experiences

Activity My Participation

Cloverbuds

Federation Meetings

Exec. Committee Meetings

4-H Week

Round-Up Banquet

Santa’s Workshop

Fruit & More Sale

Communication Arts

4-H Camp

Day Camp

Club Tour/Picnic

County Demonstration

Performing Arts

Foods Revue

Fashion Revue

Fair Clean-Up

Foodstand Worker

County Fair Exhibit

State Fair Exhibit

Others (list)


County-Wide Youth Leadership

Position My Involvement

Federation Officer

Ambassador

Day Camp Counselor

Camp Counselor

Trips/Activities My Involvement or What I Learned

BLU

YELLO

Washington Focus

State Exchange

Youth Leader Workshop

Ambassador Workshop

County Fair Assistant

(clerk, announcer, judges helper)

Other (list)

Reflection

Looking back over this past 4-H year, what was the most fun?

What did you learn in 4-H this year?

What could you do to improve 4-H involvement for yourself and others?

Personal 4-H Story

Write a story of your favorite 4-H experience, how you have grown, and some challenges you have or will face in 4-H. Use additional paper if necessary. May include photos and mementoes.

4