Clinton County by ls723a4r



                     Clinton County 4-H Award Application Cover Page
Members 14 and under please use current Clinton County Award Applications.
Members 15 and older have the option of using the Clinton County Award Application or the Illinois State 4-H
Award Application (those wishing to have their award applications submitted for State Awards must use the Illinois
State 4-H Award Application).
If this Award Application is turned in hand written it must be in the member’s writing only .

   1. Submit one completed copy of the award application for each award category.

    2. Fill out this form. Office staff will fill in the Member ID # and date submitted. Please
       mark age group and check all categories in which you are applying for an award.

    3. Turn in to Club Leader’s by the last Friday in August. They will submit them to the
       office after they are signed. Applications missing approval signatures will not be

4-H Member ID # ________________(office use) Date Submitted ______________(office use)
Age Group as of Sept 1    Cloverbud____ 8-11_____12-14_____15 & up_____

  Animal Science                      Engineering & Technology          Food, Nutrition & Health
  __Beef                               __Aerospace                      __All Foods & Nutrition projects
  __Cat                               __Bicycle                         __Cake Decorating
  __Dairy                             __Computer Science                __Candy Making
  __Dog                               __Electricity                     __Health
  __Goat                              __Geospatial                      __Sports
  __Horse & Pony                      __Robotics
  __Poultry                           __Small Engines                   Home & Family
  __Rabbit                            __Tractor                         __Child Development
  __Sheep                             __Video/Filmmaking                __Consumer Education
  __ Small Animal/Small Pets          __Welding                         __Entrepreneurship
  __Swine                             __Woodworking                     __Intergenerational
  __Vet. Science                                                        __Interior Design
                                      Environment & Natural Res.        __Sewing & Textiles
  Community Involvement &             __Camping
  Global Awareness                    __Entomology                      Personal Development
  __Citizenship                       __Forestry                        __Communications
  __Intercultural                     __Geology                         __Leadership
  __Service Learning                  __Natural Resources               __Photography
                                      __Sportsfishing                   __Theater Arts
  Plants & Soils                      __Wildlife                        __Visual Arts
  __All Crops Projects                                                  __Collections (scrapbooking/farm models)
  __Floriculture                                                        __Reading
  __Plant & Soil Sciences

    The amount of points each item is worth is in parenthesis for your information as you work on your award
    application. When it is returned to you after judging the total score and any notes from the awards judges will
    be included.

Revised February 2012

                          Clinton County
                        4-H Member Award

This record is a summary of what you have accomplished in 4-H this year. Read
all instructions at the beginning of each section carefully. This record will be used
in evaluating your progress for the year and will be the basis for award selection.

Name                                             BIRTHDATE


                           Statement by Member
I personally have prepared this application and certify that it accurately reflects my

Signature of 4-H member                                            Date

                         Approval of This Report
We have reviewed this application and believe it to be correct.

Signed (Parent)                                                    Date
Signed (Leader)                                                    Date

Revised February 2012

4-H Project - Enrollment and Exhibits

List only the information pertaining to the award category you are applying in. If you exhibited
more than one project in this category, list all that apply. See front page for Award Category

Award Category Visual Arts    Project Name(s)Clay, Metal, Fiber
Award Category Crops           Project Name(s) Corn, Soybeans
Award Category Dairy            Project Name(s) Dairy II

Award Category________________ Project Name(s)_________________________________

Number of years in this project_____

County Rating circle all that apply for this project area- Blue (10) Red (5) White (3)

State Fair____, State Fair Alternate____, Best of Show____, Special Honors for animal
shows______ ( 10 each, check all that apply to this project category)

Knowledge and Skills -List things you learned in this project (6 pts each/30 pts max)

                                                             Score for this page:
Revised February 2012


Total Number of Club Meetings           Number of Club Meetings Attended
                                        (1pt if attended at least 2/3)

List all the 4-H events you participated in this year. In the end column, write the letter indicating
at which level you participated. Do not list regular Club meetings, they are counted above. Don’t
forget to include special club activities like guest speakers, club parties, workshops, talks and

L - Club activity               C - County activity             MC - Multi-county activity
S - State activity              N - National activity           R-Regional

Name of Activity(1pt each/ 20 pts max)                                             Level

Revised February 2012                                    Score for this page:

(1pt each/20 pts max)
List all the community/school/church activities you participated in this year. In the end column,
write the letter indicating at which level you participated. DO NOT include 4-H activities on this

Com-Community                        Ch-Church                                 Sch-School

Name of Activity                                                                   Level

                                                        Score for this page:
Revised February 2012

LEADERSHIP (5 pts each/ 50 pts max)

On this page list all your leadership responsibilities that pertain to this year. Leadership is described as anything
that you TAUGHT, PLANNED or CONDUCTED which involved a group of any size. This covers 4-H,
community, school, and church leadership responsibilities. In the column on the right use the letter that represents
which area of leadership was performed. Helping or assisting with a program does not meet the definition of

L - Club leadership                       C - County leadership              S - State leadership
CH - Church leadership                    SC- School leadership              CO - Community leadership

OFFICE HELD                                                                       Club (5) County (5) State(10)
List office held and check level served

COMMITTEES                                                                        Club (5) County (5) State(10)
Check level served, if you were chairman of the committee put a “CH”

                                                                          Score for this page:

Revised February 2012

                                 MY 4-H STORY (up to 60 pts)

Your story is an important part of your award application. It gives you the opportunity to
highlight what you feel is your most important accomplishments during the 4-H year. You can
tell about how 4-H has contributed to your self-respect and concern for others or how 4-H has
boosted your confidence and attitude in life. If 4-H has helped you become a better leader and
citizen talk about it here. Do not include your name, or club name in your 4-H story. Write an
age appropriate story.

Judging will be based on the following criteria

I. Project area & years in that project
        Things learned
        Successes and failures
II. The impact this project or the impact 4-H has had on your life
        Leadership examples
        Citizenship examples

Revised February 2012

Story Score:

Total Award Application Score:

Judges Notes:

Revised February 2012

To top