Simplified 4-H Record

Year      

Club	     	County	     	
				
Name	     		
Address	     		
Birthday	     		
This is my       year in 4-H		
Name of Project 	     		
Things I learned in my 4-H Project	Picture of Yourself	
     	
Size of Project:	Number of animals      	Number of dishes prepared      	
	Number of birds      	Number of clothing articles made      	
	Number of articles made      	Other      	
 
Kansas State Agricultural Experiment Station and Cooperative Extension Service

For My Permanent Record

I am in the       grade at (Name of School)      
I have attended (Number)       meetings of my 4-H Club this year and (Number)       project meetings. 
I have held the following office in my club: (If an officer)      .
Committee(s) I have been a member of:      
I gave the following talks or demonstrations at my 4-H meeting:
     
I have attended (mark those events you have taken part in):  Club Tour,  Club Picnic,  Club Party, 
 Officers’ Training School,  County Camp,  County 4-H Day,  Regional 4-H Day,  County 4-H Achievement Party,  Judging Schools,  Demonstration Schools,  County Fair, and  Others      
I exhibited at the fair (Name of Exhibit)       and received (Number and Color)       ribbons.

My 4-H Story
(Tell briefly what you liked about 4-H and some of the things you have done.)
     	

Record Approved by ________________________ Signed ____________________________________
				(Your Leader) 					(Your Name)

Kansas State University Agricultural Experiment Station and Cooperative Extension Service 
P1052 	November 1982 
It is the policy of Kansas State University Agricultural Experiment Station and Cooperative Extension Service that all persons shall have equal opportunity and access to its educational programs, services, activities, and materials without regard to race, color, religion, national origin, sex, age or disability. Kansas State University is an equal opportunity organization. Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, as amended. Kansas State University, County Extension Councils, Extension Districts, and United States Department of Agriculture Cooperating, Marc A. Johnson, Director. 
File code: 4-H & Youth 2