4-H Logo Protected Under 18 U.S.C. 707	4-H 511

MARYLAND 4-H SUMMARY RECORD

Use tab key to move cursor to each field. Field will expand as you type.

This record belongs to:	Year:

Name

Mailing Address:	(Street):	(Apt. #):

(City/Town):	(State) :	(Zip):

Please indicate age as of January 1st:

4-H Age—Please check:	Junior (8-10)	Intermediate (11-13)	Senior (14-18)

Birth Date:	Grade in School:	Years in 4-H:	County/City:

4-H Club(s):

These are my 4-H goals for this year:

My 4-H projects this year; number of years in project:

I have evaluated by records and believe they are complete and accurate.

Signed

4-H Member	Date

I have reviewed this record book.

Signed

Volunteer	Date

Comments:

Club Participation
Number of Meetings I Attended (check or make notes)

Jan	Feb	Mar	Apr	May	June	July	Aug	Sept	Oct	Nov	Dec

Committees & Offices (4-H & Other)
Name of Committee/Office/Role	Description/What I Did

Promotional Activities
I promoted or publicized 4-H in these ways during the year (for example, news articles, TV, radio, 4-H Ambassador responsibilities, displays, fair booths, flyers, new member recruitment, expansion efforts):

Date	Activity

Be Specific – Explain Activity & Location	Results

2

Communication Activities
I took part in the following communication activities (for example, judging, demonstrations, illustrated talks, public speaking, conference judging, reports at club meetings, community groups):

Date	Type of Communication	Title	Event or Location

Awards and Honors
Include 4-H awards and honors such as fair and county recognition (you may add additional pages)

Date	Activity/Event	Award	Location

3

Journal of Activities, Events, and Experiences

Use this page to record all activities, events, and experiences as you have them. Include 4-H, volunteer, community, citizenship, leadership, service learning, school, and other activities.

Date	4-H Event	Type of Activity or Event	Location	Description
(Add other pages as needed)

Developed by

L. Martin Hamilton

Alice Hevner

Mary Ellen Waltemire

Issued in furtherance of Cooperative Extension work, acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, University of Maryland, College Park, and local governments. Thomas A. Fretz, Director of Maryland Cooperative Extension, University of Maryland.

The University of Maryland is equal opportunity. The University’s policies, programs, and activities are in conformance with pertinent Federal and State laws and regulations on nondiscrimination regarding race, color, religion, age, national origin, sex, and disability. Inquiries regarding compliance with Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Educational Amendments; Section 504 of the Rehabilitation Act of 1973; and the Americans With Disabilities Act of 1990; or related legal requirements should be directed to the Director of Personnel/Human Relations, Office of the Dean, College of Agriculture and Natural Resources, Symons Hall, College Par, MD 20742.

P2000

Washington County

2002-01-12

Jake Thompson

UMD-AGNR