4H Activity Record Year 20 20 - PDF document

1 4-H Activity Record Year: 20- 20_____
4-H Activity Record Year: 20- 20_____ Every 4-H club member must complete 4-H Activity Record per club each year. This activity record is a record of your participation in the 4-H program from October 1st through September 30th and is worth a possible 20 points of your total project score. This Activity Record must be turned in with your 4-H project book(s) to your 4-H Club Leader in September. Stion 1 MembeInformation ________________________________________________________________________ ____________________________________________________________________ Bir Date: ______________ Ag _________________________________________________________ S ec tion 2 Club Participation P o s s i b le S c o r e 7 0 % o r m o re =3 p t s 60 - 6 9 % = 2 p t s M o re t h an 5 0 % =1 p t . Y ou r S c o r e 4 - H M em b e r s s hould b e a cti v ely en g aged in t heir c l ubs a nd at t end a m ajor i t y of t heir club meeti n g s . Nu m b e r of m e e t i n g s h e l d: _____ ___ Nu m b e r I a tt e n d e d: ________ P er c e n t: _ _______ % 1 E ach 4 - H’er is r eq u i r ed t o g ive a t lea s t 1 p r o ject t alk o r visual prese n t ati o n per yea r . M onth of Vis ual P r e s entat i on or Pro j e c t Ta lk : _ _____________________________ T i t l e of Vis u a l P r e s entat on o r P r o j e c t Ta lk : _______________________________ Possible Score Your Score 1 point per activity up to 4 points List m onth 4 Led the pledge _______ Made a motion _______ Seconded a motion _______ Led a song _______ Led a game _______ Gave a report _______ Made or served refreshments _______ Participated in a program _______ Led or taught a program _______ Helped with a club fundraiser _______ Helped with a service project ______ _ Helped another member _ ______ Other 4 - H club activity _ ______ 1 A l l 4 - H m e m b e r s s h o u l d s e rv e th ei r cl ub as e i t h e r a n o ff i c er or o n a c o m m i tt e e. Officer: ____ __________________________________________________________ C l ub Co m m i tt e e: _ _ S ec tion 3 County 4 - H Program Activities : 1 point per activity up to 4 points List month Possible Score 4 Your Score 4 - H Achievement _______ Judging or other Team _______ Officer Training ___

2 ____ 4 - H Project Workshop
____ 4 - H Project Workshop _ ______ Tri - County Camp _______ 4 - H Concessions at Fair _______ Other ___________________ _____________________________ __ __ _____ This is a complete and accurate record of my 4-H activities for the current 4-H year. I understand that my activity record will not be valid and my score will not be calculated until all signatures are collected. Signature of 4-H Member Date Signature of Parent/Guardian Date Signature of 4-H Leader Date Programs and activities offered the West Virginia University Extension Service are available to all persons without regard to race, color, sex, disability, religion, age, veteran status, political beliefs, sexual orientation, national origin, and marital family status. S ec tion 4 Community Service / Citizenship Activities : 1 point per activity up to 2 points P o s s i b le S c o r e 2 Y ou r S c o r e List all community service and citizenship activities in which you participated. (Ex: Community Clean - Up, Recycling, Food Drive, etc.) A. _ ______________________________ B. _ ______________________________ Other _ _______________________________________________________________ S ec tion 5 Leadership Activities : 1 point per activity up to 2 points Possible Score 2 Y ou r S c o r e List all leadership roles in Club, School and Community (Ex: Bud Day Volunteer, Camp Counselor, Tribal Leadership, Mentoring, Tutoring , Student Council, etc.) A. _ ______________________________ B. _ ______________________________ Other _ _______________________________________________________________ S ec tion 6 State / National 4 - H Activities : 1 point per activity up to 2 points - List month Possible Score 2 Y ou r S c o r e State Camp ________ Extension Camping Instructor ________ State Fair ________ State Judging Contest ________ State 4 - H Days ________ State 4 - H Photo / Poster Contest ___ _ ____ National 4 - H Week ________ National 4 - H Co nference ________ Other : _ ______________________________________________ ____ ___ _____ S ec tion 7 Awards & Recognitions List all the 4 - H awards and recognitions you have received this year. Club: ___________________________________________________________________ _ _________ ________ County: ____________________________________________________________ ______________ _________ State: _____ ______ _________________________________________________________________________ S ec tion 8 Activit y Record Turn - In Possible S core 1 Your Score This Activity Record was turned in to the Club Leader by the designated date: __________ YES _ _________ N