DC02-1

4H PROJECT AWARD FORM

Objective: To recognize a 4H member for achievement in a project area

4-H’er may apply for 3 project awards per year

Project Awards are earned by attaining goals stated in this form.  All 4-H’ers meeting these requirements will be recognized once on the county level.   All 4-H’er achieving the county project award are greatly encouraged to expand the project, continue record keeping to show progress toward superior achievement and submit application toward state recognition in their 9^th through 12^th years.

4-H’ers Name___________________________________  Project___________________________

Last Grade Completed____  Current Age____  Today’s Date____  Club_______________________

Have your received this project award?___No ___Yes (if yes, do not apply for this project award)

The above 4-H’er has completed the following requirements to receive recognition in this project.

___  Number of years enrolled in this project.  (minimum of 2)

___  Goals are clearly stated and completed in this project

___  Records reflect goals, what 4-H’er did and learned and future plans

___  Participation Summary has been completed

___ 4-H’er has been involved in a minimum of 6 hours of 4H educational instruction/activity

        (4H club meetings, workshops, etc.) this year.

___ Two years of financial records are included with records on this project.

Additional criteria:   Check all that apply but must have a minimum of 5

1. ___ 4-H’er helped or taught others about this project.   Briefly describe: _____________________ _________________________________________________________________________________

2. ___ 4-H’er did a community service/citizenship project in this area.  Briefly describe: __________ _________________________________________________________________________________

3. ___ 4-H’er has kept a complete record for 2 years on this project.

4. ___ 4-H’er gave an educational presentation/working exhibit at their club in this project area

               Date_________  Title__________________________________________________

5. ___4-H’er gave an educational presentation/working exhibit at the county level in this project area

               Date_________  Title__________________________________________________

6. ___ 4-H’er exhibited in this project at the Davis County Fair.  Briefly describe exhibits (ex. Photo of sunset):________________________________________________________________________ _________________________________________________________________________________

7. ___ 4-H’er exhibited in this project at the Iowa State Fair, Ak-Sar-Ben, American Royal, etc.

8. ___ 4-H’er attended a workshop/training/activities/events outside of club in this project.   Name of event__________________________  Location__________________________________________

9. ___ 4-H’er has outlined a plan for achieving area/state recognition in this project as a 9^th – 12^th grader

Comments:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Interview conducted on:    _________________   By:_____________________________________

                                                    (date)                                         (interviewer signature)

4-H’er Signature______________________________________    Date________________

Approval by Leader____________________________________   Date________________

                                                   (leader signature)

This form should be signed and returned to the Extension Office by the October 1^st deadline date.