isu extension, madison ounty 4 h · 2017. 8. 2. · isu extension, madison ounty 4-h. application...
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ISU Extension, Madison County 4-H
Application for Bronze, Silver, and Gold Club
Participation Award (4th-12th grade Community Clubs)
Clubs are eligible to apply every year for any level of this award. This award is open to all community 4-H clubs and
special interest clubs for youth grades 4-12. Please be sure all club activities are properly documented in your club’s
secretary minutes.
Application deadline: September 22, 2017 by 4:30 p.m. to Madison Co. Extension office. (No late entries will be accepted)
Club Name______________________________________________________________________________
Club Leaders_____________________________________________________________________________
Bronze Level
____ Adult and Youth have attended at least 25% of 4-H and Youth Committee meetings.
____ The club has participated in 1 community service activity.
Activity:_________________________________________________________________________
____ Communications: At least 50% of club members grades 4-12 gave a presentation at a 4-H meeting or 4-H function during the 4-H Club year (September 2016-August 2017). ____ The club has fulfilled an assigned duty at each of the following : Covered Bridge Festival booth, fair 4-H food
stand, Jackson Building monitoring, and fair set up/tear down responsibilities.
Silver Level
____ The club has fulfilled all Bronze Level requirements (please indicate with check marks above)
____ Adult and Youth have attended at least 50% of 4-H and Youth Committee meetings.
____ The club can meet at least two of the following (please indicate below):
_____ The club has participated in an additional community service activity.
Activity:___________________________________________________________________________
_____ At least one member of the club has attended a regional, state or national 4-H activity.
(4-H Camp, Animal Science Round-Up, State 4-H Conference, Citizenship Washington Focus, etc.)
_____ The club has participated in 4-H Extravaganza.
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Gold Level
____The club has fulfilled all Silver Level requirements. (please indicate with check marks on front page)
____Adult and Youth attend at least 75% of 4-H and Youth Committee meetings.
____The club has met at least three of the following (please indicate):
_____ Club members have served on a 4-H and Youth Committee subcommittee.
_____ The club has contributed to 4-Hers for 4-H.
_____ At least three members of the club have attended a regional, state or national 4-H activity (4-H Camp,
Animal Science Round-Up, State 4-H Conference, Citizenship Washington Focus, etc.). Please list youth
name & activity.
1.) _______________________________________
2.) ________________________________________
3.) ________________________________________
_____ Club leaders, members or families have nominated a potential recipient of a community/adult
recognition award
_____ The club has coordinated a county wide 4-H related event.
Date of Event: _______________________________
Description of Event: ____________________________________________________
_____________________________________________________________________
Club President’s Signature _______________________________________________________________
Club Leader’s Signature _________________________________________________________________
Revised 2/17/2016
The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and
activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual
orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Many materials
can be made available in alternative formats for ADA clients. To file a complaint of discrimination, write
USDA, Office of Civil Rights, Room 326-W, Whitten Building, 14th and Independence Avenue, SW, Wash-