Kansas 4-H Permanent Record

Bring up to date at the end of each year.  
Name	      	Address	     	
Club	     	County/District	     	Birth Date	      	

Section 1—Groups/Organizations 
List all groups/organizations you participated in, i.e. 4-H, school, community and/or faith. If the group is non 4-H related enter an * in the non 4-H column. For each group, list elected offices (such as reporter, vice president, etc.) and other positions or roles you held (such as junior project leader, project leader, committee chairman or committee participant). Indicate the total number of meetings held, the number you lead and the number of meetings you attended in the appropriate level column. Hours (includes preparation, organization, practice and activity time, but does not include travel, sleeping, meals, etc.) are optional, but may be useful for other applications. This section is used to complete the Meetings, Committees, Offices part of Section 3 and Section 5 in the KAP.

						Level	Optional	
Date	* = Non 4-H	Meetings, Committees, Offices, Leadership Roles	# Held	# Led	# Attended	Local	County/ District	Area/ Regional	State	National/Int’l	Hours	

												

												

												

												

												

												

												

												

Section 2—Communications/Presentations, Exhibits, Contests
List all projects completed. If the group is non 4-H related enter an * in the non 4-H column. Examples include, but are not limited to, fair exhibits, judging contests, quiz bowls, skill-a-thons, demonstrations, illustrated talks, project talks, articles written, web pages developed, TV or radio presentations, county/district and regional club days activities, forensics and debate contests, fitting and showing, tractor driving, fashion revue, dog shows, horse shows, photography exhibits, etc. Size of Project may be indicated by the number of garments, animals, acres, articles made, hours involved, or another identifier of your choice. For contests, indicate whether it was an individual or team effort. For evaluated activities (exhibits and contests) indicate the number and placing with the appropriate letter: Purple (P), Blue (B), Red (R), White (W) and Participation or Other (O) in the level column. Hours (includes preparation, organization, practice and activity time, but does not include travel, sleeping, meals, etc.), audience and income/expense are optional, but may be useful for other applications. This section may be used in completing the Summarization of Project Experiences/4-H Experiences of Section 2 and What You Did of Section 3 and 5 in the KAP.

					Level	OPTIONAL	
Date	* = Non 4-H	T = Team	Size of Project	PROJECT
Communications, Presentations,
Exhibits,
Contest, Judging or
 Skill-A-thon	Local	County/District	Area/Regional	State	National/Int’l	Hours	Audience	Income/ Expense	

													

													

													

													

													

													

													

													

													

													

Section 3—Activities
List the events and activities (not included in other sections of the permanent record) that you attended or participated in for 4-H, school and community. Examples include achievement programs, talent shows, camps, regional 4-H days, nursing home programs, sponsorship of club or county awards, fairground clean up, assistance to fair superintendent, special fund-raising efforts, band, teams, or FFA. If the activity was non 4-H related enter an * in the non 4-H column. Indicate whether your involvement was leadership, citizenship or both and the level of participation in the level column. Hours (includes preparation, organization, practice and activity time, but does not include travel, sleeping, meals, etc.), audience and income/expense are optional, but may be useful for other applications. This section is used to complete the Summarization of Project Experiences/4-H Experiences of Section 2 and What You Did of Section 3 and Section 5 in the KAP.
Leadership is teaching another person or a group skills or information and includes organizing or coordinating an activity, event, or meeting; selecting and preparing materials; and selecting presenters. 
Citizenship means helping out in your community and serving others without compensation.  

					Level	OPTIONAL	
Date	* = Non 4-H	Leadership	Citizenship	What You Did	Local	County/District	Area/Regional	State	National/Int’l	Hours	Audience	Income/
Expense	

													

													

													

													

													

													

													

													

													

													

													

Section 4—Most Important Recognitions
List the most important recognitions you received during the year—honors, awards, out-of-county trips, etc. Example: Camp Scholarship, National 4-H Congress, 4-H Key Award, County Project Award, School Achievement Award, Letter. If the recognition is non 4-H related, identify it with an * in the non 4-H column. The section is used to complete the Awards & Recognitions portions of Section 4 and Section 5 of the KAP.

			Level	
Date	* = Non-4-H	Kind of Recognition	Local	County/District	Area/Regional	State	National/Int’l	

								

								

								

								

								

								

								

								

								

								

								

Kansas State University Agricultural Experiment Station and Cooperative Extension Service 
P-1032 (Revised)                                                                                                                                                                          October 2008
K-State Research and Extension is an equal opportunity provider and employer. 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, Fred A. Cholick, Director.