Waukesha County 4-H Record Book
Age 12-14 Version (as of Jan 1)
This year: 20____/20____
Info slide only - add information on all the slides as directed to “tell your 4-H story”
Estimated length of time to complete:
Cloverbud- 30 minutes
9-11 years old: 1-2 hours
12-14 years old: 3-4 hours
15-19 years old: 5-6 hours
You can use full sentences or bullet points to share your information.
You are encouraged to add photos to your slides.
You are free to add additional slides if you like.
You can add a background or design of your choice if you like.
Do not change the header describing what belongs on each slide.
Don’t forget to fill out the separate awards application form for any awards you are applying for, and the ME form to be considered for any travel scholarship awards.
Record Book
Insert Picture of Yourself
NAME | | |||||||
ADDRESS | | |||||||
CITY | | STATE | | ZIP | | |||
PHONE | | | ||||||
GRADE COMPLETED | | AGE (as of Jan 1) | | Years in 4-H | | |||
PARENT/GUARDIAN NAME | | |||||||
CLUB NAME | | |||||||
4-H Participation: Place an X in each 4-H element you participated in this year:
| Attended Club General Meetings | | Club Fundraiser |
| Committee Member (Club or County) | | County Fundraiser |
| Club Officer | | Waukesha County Fair |
| Promoted 4-H in Community | | State Fair |
| Community Service Activity | | 4-H Camp |
| 4-H Open House | | State Art Camp |
| County 4-H Awards Event | | Camp Counselor |
| Performing Arts Day | | Teen Council |
| Worked at 4-H Food Stand | | Project Junior Leader |
| Waukesha 4-H All Leader Meeting | | 4-H Fall Forum |
| Attended Project Meetings | | Wisconsin Leadership Council |
| Project Demonstration | | State Arts Team, Drama, Communications, etc |
| | | |
Non-4-H Activities
List other activities you participated in this year outside of 4-H: (sports, clubs, church, school, etc)
Participation & Belonging: Describe what you enjoy most about being in 4-H:
Participation & Belonging: Highlight meaningful 4-H experiences you participated in this year:
Participation & Belonging: What impact have these had on you or what did you learn in these experiences?
Participation & Belonging: Describe how you contributed to the success of your 4-H club?
Participation & Belonging: Explain how you helped to promote 4-H this year to others?
Participation & Belonging: Share at least 1 participation/ belonging goal for next year:
Project Achievement & Mastery: Did you do a demonstration in your project? If yes, describe demo & where did you do it? If no, you may delete this slide
Project Achievement & Mastery: List your 4-H projects enrolled in this year:
Project Achievement & Mastery: Where did you exhibit your projects this year?
Project Achievement & Mastery: List any achievements or special awards in your projects you would like to highlight:
Project Achievement & Mastery: Describe what are you most proud of in your project work this year:
Project Achievement & Mastery: Describe an impactful learning experience in your project work this year:
Project Achievement & Mastery: In what way will you carry the life skills learned through your projects forward into your future?
Project Achievement & Mastery: Share at least 1 project goal for next year:
Citizenship/ Generosity: List Community Service Activities and hours for each that you participated in this year:
Estimate total hours of community service this year:
Citizenship/ Generosity: Describe which community service activity you enjoyed the most and why:
Citizenship/ Generosity: Why is it important to help others in your community?
Citizenship/ Generosity: Share at least 1 citizenship/ community service/ generosity goal for next year:
Leadership/ Independence: List any leadership roles you have had in 4-H this year:
Leadership/ Independence: Describe a leadership experience that was most impactful to you this year?
Leadership/ Independence: What did you find challenging in your leadership role this year?
Leadership/ Independence: What leadership skills did you develop this year?
Leadership/ Independence: Give an example of how you developed independence in some element of 4-H this year:
Leadership/ Independence: How did your 4-H leadership impact others this year?
Leadership/ Independence: Share at least 1 leadership/ independence goal for next year:
Honors & Awards Tracking: List the year you accomplished each of these:
| Spark Award | | |
| Bronze Medal | | Waukesha Youth Leadership Conference |
| Silver Medal | | Space Camp |
| Gold Medal | | WI Summer Academy |
| Achievement Medal | | American Spirit |
| Citizenship Medal | | Citizen Washington Focus |
| Leadership Medal | | National Congress |
| Key Award | | National Conference |
| Danforth Leadership Award | | |
| College Scholarship | | |
Honors & Awards Tracking: List the year you accomplished each of these:
Project Medals:
Year | Project | Year | Project |
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Honors & Awards Tracking: Other Honors & Awards this year:
Photos: Please add slide(s) with 4-H photo highlights from this year here