2022 4-H Participation (for Achievement Program Certificates)
Youth will be recognized for their 2022 4-H participation and achievements at our upcoming Achievement Program. Please answer the questions below in order for your child to receive an accurate certificate at our Achievement Program. Please check all 4-H events/clubs that youth participated in for 2022 (only include 2022 participation; do not include what they may have done in years prior).

Please complete this form no later than February 10, 2023.
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Email *
Name of person filling out this form: *
4-H'er Name: *
Club(s) 4-H'er was a member of in 2022: *
If your child was a member of multiple clubs in 2022, which do you consider as his/her primary club? *
Please indicate how many years of service the 4-H'er has had up until December 31, 2022. *
Please check each of the events below that this 4-H'er participated in for 2022 (there is a NONE option at the bottom if needed): *
Is this 4-H'er graduating from high school in Spring 2023? *
Thank you for completing this form to assist us in recognizing your 4-H'er during our Achievement Program! We hope you'll attend the event on Friday, February 24 at 6:30 PM. Families will have to RSVP in 4-HOnline under "events". A meal will be served. If you have questions, please contact 4-H Agent Laura Allen at laura_allen@ncsu.edu or 704-216-8970.
A copy of your responses will be emailed to the address you provided.
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