The awards that require a completed project summary form are:
• Heard and Heart Award • Ambassador Award • County Medal • State Award
Credits for the following work are given cumulatively - that is, you should include all your 4-H work from age nine through the present. If something applies to more than one category, DO NOT REPEAT INFORMATION.
| 1. | Calendar years of 4-H work (2 points for each year) | _____ X 2 = _____ |
| 2. | Projects carried (1 point for each year for each project, attach list) | _____ = _____ |
| 3. | Projects carried
through for three or more years 5 points for each project, attach list |
_____ X 5 = _____ |
| 4. | Number of years 4-H
project records were kept (including but not limited to Members Personal
Record Book, log sheets, calendars, etc.) 5 points per year |
_____ X 5 = _____ |
| 5. | Calendar years of teen leadership (either as a project or by acting as an assistant leader; you do not have to have shown under Teen Leadership at the Fair) 5 points per year | _____ X 5 = _____ |
| 6. | Offices held in
local and/or county clubs. 5 points per office per year, attach list |
_____ X 5 = _____ |
| 7. | Active
participation on a county or state 4-H committee. 10 points per committee per year, attach list |
_____ X 10 = _____ |
| 8. | 4-H program service: 4-H events where you carried out some responsibilities (for example, Fair activities, county Style Show, Out of State Exchange planning, assisting at a showmanship clinic, teaching or helping at a Tri-County Workshop, etc. (5 points per year, attach list) | _____ X 5 = _____ |
| 9. | Community service:
activities that benefitted others (not fund-raising efforts for your club)
5 points for each 4-H related community service, 2 points for non 4-H,
attach list) MAXIMUM OF 100 POINTS TOTAL FOR SECTION #9 |
_____ X 5 = _____
_____ X 2 = _____ |
| 10. | Membership in a county 4-H organization (for example, 4-H Council, a 4-H quiz team, Ambassadors, a 4-H judging team, etc.) 5 points each plus add two points for each year of involvement, attach list | _____ X 5 = _____
_____ X 2 = _____ |
| 11. | Talk or report
about 4-H given to or for a non-4-H group (service clubs, women's groups,
Soil Conservation, school, etc) 10 points for each, attach list |
_____ X 10 = _____ |
| 12. | 4-H presentations
given at your club and/or at the Fair. 10 points for each |
_____ X 10 = _____ |
| 13. | Participation in
special State 4-H programs, activities, contests (for example, Exploration
Days; Vet-a-Visit; Kettunen Center, KBS or Tollgate workshops; Capitol
Experience; Washington Focus; Interstate Exchange; Horse Jamboree; Animal
Science Week [Dairy Days, Caprine Expo, Rabbit Expo, etc]; State shows
[horse, rabbit, goat, etc.]; State 4-H contests [shooting sports, etc.]) 10 points for each, attach list |
_____ X 10 = _____ |
| 14. | Participation in
4-H awards program: 1 point for each year you applied 2 points for each medal you won 10 points for each state award application |
_____ yrs. X 1 = _____ _____ medals X 2 = _____ _____ apps X 10 = _____
|
TOTAL ________________
I have completed this form and believe it to be a true reflection of my 4-H work.
__________________________________________________ (Member's signature)
I support this member's participation if s/he is selected.
___________________________________________________ (signature of parent or guardian)
ATTACH A STATEMENT FROM YOUR 4-H COMMUNITY LEADER OR PROJECT LEADER OTHER THAN YOUR PARENT. APPLICATIONS WITHOUT A LEADER'S RECOMMENDATION CANNOT BE CONSIDERED.