DES MOINES COUNTY
APPLICATION FOR COUNTY-LEVEL PROJECT AWARD
This form should be submitted with records to the Extension office by OCTOBER 1
All 4-H members in 5th-12th grades may apply for awards.
You should include information about your work for the entire time you have taken
this project. Do not limit yourself to work done at the fair or for a single year.
Objective: To recognize high level of excellence in project work at the county level.
Member’s Name _______________________________________ Today’s date _________
PROJECT AREA __________________________________ Completed Grade _________
Have you received this project award before? ___________ When? ______________________
1. I enrolled in the project for at least 2 yrs. Must be enrolled in current year.
2. I attended a minimum of 50% of club meetings/club activities this past year.
3. I have evaluated my project through ONE of the recommended methods below.
Circle which one you used.
4-H Project Record Project worksheet/manuals
Videotape Audio tape
Portfolio Computerized form
My own record-keeping system
On the back of this form, fill out the chart with all of the information about work/activities done in
this project area for all the time you have taken it and complete the written summary.
For office use only
______ Member has turned in records
Year Activities or Activities or Activities or Activities or
projects done at projects done at projects done at projects don at
Club level County level Area level State level
Write a short summary that describes your feelings about your accomplishments and participation.
1 or 2 members of the 4-H Youth Committee will visit with you in person at the Extension Office about
your project area.
Signed by 4-H’er: _________________________________________ Date ___________
Approved by Leader: __________________________________________________________