Permanent Member Record

Moultrie-Douglas 4-H Permanent Member Record

This record is a summary of your accomplishments throughout your 4-H career. This record can be used for evaluating your progress and planning future work. It will also be the basis for award selection.

Name______Date of Birth ______

Address ______Street

______City State Zip Phone

Club Name ______Years in 4-H ______

Participation in Local 4-H Club

YEAR Total Total number Number Committees of Club Club Club Office Held (If you chaired a committee, designate Meetings Meetings with ch) Attended

Codes for project enrollment and exhibits sheet County Fair – CO Blue Ribbon – A Red Ribbon – B White Ribbon - C

State Fair – SF Award of Excellence – AE Superior - S

4-H Projects – Enrollment & Exhibits Begin with your first year in 4-H and list the year, project name and grade received at your county 4-H fair and at the state fair. Use one row for each year. More than one project can be listed in each box.

Year Project CO ST Project CO ST Project CO ST Example: 2004-2005 Aerospace A S Corn A AE You Learn to A S Bake

Participation in 4-H Program (put month and year of program/activity)

Program Where Year Year Year Year Year Year Year Year Year done?

Attended Club Achievement Program County Camping – County 4-H Camp or Regional other 4-H related camps State Club Citizenship County 4-H County Ambassador, Jr Leader or Regional other 4-H Leadership Groups State County Judging: Aerospace Livestock Regional Horse Meats Poultry State Forestry Horticulture Dairy National Wildlife

Helped with Club 4-H fundraising County Club Officer Training County County Conferences Regional (i.e. Leadership, State legislative etc…) National Health & Safety Club County Club Community County Service State Animal County showmanship State class Tractor State Operations Contest National Club Public County Presentations State National

Community Activities Summarize activities you have participated in your school, community and church. List the year, group or organization, and list offices held and committees chaired. List any honors or recognition you earned in these activities. Include scouts, little league, school sports, band, student council, or church leadership positions you have held.

Year Clubs/Groups/Organization Offices/Committee Awards/Recognitions s s Example: 2002 Student Council Secretary

4-H Leadership & Appearances in Support of 4-H Experience as a Junior Leader or Ambassador

YEAR Experience

4-H Honors & Recognition List honor member awards, certificates, trips, trophies, grand champions, state fair and special recognition awards.

YEAR Recognition

Approval We have reviewed this record and find the information current and correct

Year Member Parent/Guardian Leader