REPORT ON LOCAL 4-H CLUB PROGRAM
To be filled out by local club and submitted to County Extension Office for program in which
club awards are offered. Use separate form for each Awards Program. County Extension Office
should submit this form for the one outstanding club to State 4-H Office for State award
_________ 4-H year
Name of Local Club
Names of addresses of Local 4-H Leaders
No. of 4-H members in Club: Boys Girls Total
No. of members participating in program with which this report is concerned: Total
No. of meetings held (or to be held) by your Club:
No. of your Club meetings in which program being reported was included (or is to be included):
Write narrative answering the following questions:
1. What were the major group activities of the Club in this program?
2. What were the major and activities of individual 4-H members in this program?
3. How did the Club work with or seek support from other groups in this program?
4. What methods, procedures and techniques were particularly effective?
5. What were the important results achieved in this program? (Please indicate number of
people influenced, community action initiated and resulting community betterment.)
Use additional sheets if necessary – Pictures, newspaper clippings, letters of appreciate, etc. may
be included to make your report more complete.