Chaves County Report Form

Roosevelt County 4-H Report Form

To be typed or printed by the 4-Her I am a Novice Junior Senior 4-H Member

Current 4-H Year : October 1, 2016 to September 30, 2017

Name: Date of Birth:

Club: Years in 4-H:

Home Address:

City, State, Zip:

Name of School: Grade:

Number of Club Meetings held this year:

Number of Club Meetings you attended:

STATEMENT BY 4-H MEMBER

I have personally prepared this report and certify that it accurately reflects my 4-H work.

Date: ______Signature of 4-Her ______

APPROVAL OF THIS REPORT

1 2014 Date:______Signature of Parent or Guardian:______

Date:______Signature of 4-H Club Leader:______

2 2014 PROJECTS TAKEN THIS 4-H YEAR: (Place a “√” next to the projects that will be judged in this record book. All completed projects are eligible to be judged for awards. )

√ 4-H Project Name

3 2014 DEMONSTRATIONS, SPEECHES AND ILLUSTRATED TALKS List all presentations you have given this year related to 4-H. Include where they were presented and how many times. Include 4-H presentations on radio, TV, and school.

Title Where # of Times “How to Select Fabric for a Quilt” Dora 4-H Club 1

4-H EXHIBITS, SHOWS, FAIRS, TOURS, AND CAMPS List 4-H activities you participated in this year. Include where the activity took place and the level --- Local Club (L), County (C), District (D), State (S), and/or National (N).

4-H Activity Where Level Roosevelt County Fair Portales C

4 2014 4-H OFFICES AND COMMITTEES List the 4-H office(s) you held and committees you served on this year. Indicate the level ----- Local Club (L), County (C), District (D), State (S), and/or National (N).

4-H Office or Committee Level

4-H CONTESTS List all 4-H contests you participated in this year. List type of contest and where contest was held. Indicate the level ---- Local Club (L), County (C), District (D), State (S), and/or National (N). Contest Where Level

5 2014 4-H LEADERSHIP List your 4-H leadership experiences in helping others plan programs, lead discussions, prepare demonstrations, and project work or 4-H activities. Indicate the level - Local Club (L), County (C), District (D), State (S), and/or National (N).

4-H Leadership Experience Where Level

4-H CITIZENSHIP / COMMUNITY SERVICE List your individual or group 4-H citizenship and/or community service experiences this 4-H year and include recognition you received. Indicate the level - Local Club (L), County (C), District (D), State (S), and/or National (N). Type of Service Level

6 2014 4-H AWARDS AND RECOGNITION:

List the most important 4-H awards you received for your project work, contests, 4-H scholarships, and other recognition. Include ribbons received, honors, trips earned and recognition received. Indicate the level - Local Club (L), County (C), District (D), State (S), and/or National (N).

Type of Award Received For Level

7 2014 Non 4-H Experiences in School, Church and Community

List your most meaningful participation in school, church and community organizations other than 4-H; include leadership roles and honors received. Activity Level

8 2014 9 2014 My 4-H Story Limited to 6 pages, typed or handwritten, one side of the paper only. Emphasize your personal growth and development; leadership and community service experiences; goals for the year; club, county district, state and/or national activities you participated in.

10 2014 Project Record Form Use this form for each individual project. Items listed in this section apply to THIS project only.

PROJECT______

HOW MAY YEARS HAVE YOU TAKEN THIS PROJECT? ______

Indicate the level - Local Club (L), County (C), District (D), State (S), and/or National (N).

Judging Practices and Contests Activity Placing Leve l

Demonstrations, Illustrated Talks, Public Speaking or Radio Appearances Activity Placing Leve l

11 2014 12 2014 Jackpots, Fairs, Exhibits Activity Placing Leve l

Tours, Field Days and Buying Trips Activity Level

13 2014 Income and Expense Record Date Describe Item Income Expense

Total Income and Expenses Profit or Loss Income: prize money, sale of animals or items, estimated value of completed item or animals on hand, etc. Expenses: animal, feed, fabric, ammunition, leather, groceries, entry fees, photo processing fees, etc.

14 2014 Add Additional Pages as necessary

15 2014 About this Project List information about this project. This will help you show what you learned, growth and development in this project area. Use this information in to help you complete your 4-H Story at the end of your record book.

What did you plan on learning in this project?

What did you learn in this project?

What were your most difficult experiences?

What were your most enjoyable experiences?

Use additional pages if necessary

16 2014