Farmers & Merchants and J & C Repair

OHIO STATE UNIVERSITY EXTENSION

Henry County 4-H Honor Member Award Name: ______Age as of 1/1:______Telephone #:______Address: ______4-H Club: ______Year in 4-H (includes this year):______Number of years, including this year, you have received the 4-H Honor Member Award (please circle): 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 REQUIREMENTS: To be considered for the 4-H Honor Member Award in Henry County, members need to complete the following 1. Complete ALL items in Group I 2. Complete the minimum number of items in Group II according to your 4-H age this year: YEARS OLD NUMBER OF ITEMS 8-10 Years Old 5 11-12 Years Old 7 13-14 Years Old 9 15-16 Years Old 11 17-18 Years Old 13 3. It is the member’s responsibility to have this form signed by a club advisor and his/her Parent/Guardian, sign the form, and return it to the Extension Office no later than September 1 of current year. GROUP I (All Items Must Be Completed) _____ 1. I completed all of the 4-H projects I enrolled in this year. _____ 2. I displayed all my 4-H projects at the Henry County Fair. _____ 3. I presented my required demonstration at my local 4-H club meeting. _____ 4. I did not miss more than 5 regularly scheduled club meetings for any reason. _____ 5. I know the 4-H Pledge, the 4-H Motto and the 4-H colors. _____ 6. I assisted an advisor as needed. I did the following ______. _____ 7. I received an A grade on all the 4-H Projects I completed this year.

GROUP II (Please check the items you have completed and fill in the necessary information) _____1. I served as a member of a committee within my 4-H club. Committee:______2. I served as an officer of my 4-H Club. Office:______3. I participated in the 4-H Officer Training that was provided. _____4. I attended an educational tour with my 4-H club. _____5. I participated in my 4-H club’s community service project. (This is an activity done for the benefit of others and DOES NOT include monies collected for your 4-H club or its membership) _____6. I assisted in planning/conducting OR attended a 4-H Parent Night OR Project Tour/Share Time. _____7. I completed the Ohio Department of Agriculture required Quality Assurance provided to me either in Henry County or at an approved location/method. _____8. I attended the 4-H Livestock Round Up. _____9. I presented or made an entry in one of the categories of the 4-H Communication & Expressive Arts Contest. _____10. I participated in an Ohio 4-H event. Event: ______11. I participated in the 4-H Style Revue as part of judging. _____12. I attended my project judging on the day it was scheduled. _____13. I exhibited a project in the Junior Fair Division at the Ohio State Fair. _____14. I actively participated in the Henry County 4-H Junior Leadership Club. OHIO STATE UNIVERSITY EXTENSION

_____15. I participated in an International Exchange Program through 4-H. Location: ______Date: ______16. I participated in a county 4-H learning event/work clinic. Location: ______Date: ______17. I was an active member of the ____Horse Bowl Team ____Judging Team ____Other _____18. I attended camp (Please check those that apply) ___Henry County 4-H Camp ___Teen Camp ___Sea Camp ___State 4-H Leadership Camp ___Super Camp ___4-H Horse Camp ___Princess Camp ___Buckeye Leadership Workshop ___Kid’s Outdoor Science Camp ___Other 4-H Camp/s______19. I served as a Henry County 4-H Camp Counselor or CIT. _____20. I served as a Henry County 4-H Cloverbud Camp Counselor. _____21. I served as a Henry County 4-H Horse Camp Counselor. _____22. I served as a counselor for other 4-H Camp/s ______23. I served as a representative to the Henry County Junior Fair Board. _____24. I served as an officer of 4-H Junior Leadership Club. Office: ______25. I actively served on my Junior Leadership Club Team. Team:______26. I completed and submitted an Ohio 4-H Achievement Record. _____27. I completed and submitted a Henry County scholarship application. _____28. I attended the Ohio 4-H Teen Conference in Columbus. _____29. I completed and submitted an application for Henry County ____4-H Royalty ____Horse Royalty ____Canine Princess ____Shooting Sports Royalty _____30. I completed and submitted an application for Henry County Junior Fair ____King/Queen Royalty ____Sheep/Goat Royalty ____Small Animal Royalty. _____31. I worked in one of the following stands during the Henry County Fair. _____Beef _____Pork _____Milkshake _____Sr. Leadership _____32. I promoted Henry County 4-H through ___Radio Spot ___Article for newspaper ___Created post/flyers ___Visit to classrooms/Awareness Team ___Other ______33. I volunteered at least 4 hours at the Extension Office. What I did:______34. I serve as a representative on the Henry County 4-H Advisory Council.

I certify that I have done the items that I have checked to the best of my ability. Member Signature:______

To the best of my knowledge, my son/daughter has accomplished the items he/she has checked. Parent/Guardian Signature:______

To the best of my knowledge, this member has completed the items checked and I recommend him/her as a 4-H Honor Member for the year ______. Advisor Signature:______