University of Illinois Extension



[pic] PEORIA COUNTY 4-H YEAR FOCUS AWARD APPLICATION

For the 4-H Year of September 1 – August 31

Before completing this application please read ALL instructions.

Please type or Print

Please Check Award Applying For:

| |Sharon Iberg Ludolph Memorial Award |Outstanding 4-H Home Economics |

| | |(Includes: foods, Child Care, Clothing & Interior Design) |

| |Marsha Depperman Memorial Award |Outstanding 4-H Home Economics |

| | |(Includes: foods, Child Care, Clothing & Interior Design) |

| |Leatha Morris Award |Best 4-H Foods & Nutrition Program this Year |

| |Sandra Baughman – Barton Memorial Award |Outstanding 4-H Junior Leadership |

| |1st year Swine Award |Outstanding 1st Year Swine Program |

County: Date Submitted:

Name: Male/Female: M F

Home Address:

Telephone: ( ) Date of Birth: Month: Day: Year:

Name of Parent/Guardians:

Name of 4-H Club/Group:

STATEMENT BY MEMBER

I personally have prepared this application and certify that it accurately reflects my work.

Date Signature of Member

APPROVAL OF REPORT

Date Signature of Parent/Guardian

Date Signature of Local 4-H Leader

INSTRUCTIONS FOR 4-H YEAR FOCUS APPLICATIONS

IMPORTANT NOTE: This application form will be used to select award winners for Peoria County 4-H Memorial Awards and 1st year Swine Award only. Also award selection will only be based on the immediate past years 4-H work.

1. This application is all you need to apply for Peoria County 4-H Memorial Awards and the 1st Year Swine Award. No other records will be used in selecting winners. Competing for county awards is strictly optional and is not required of any 4-H member. The decision is yours.

2. This application is ONLY for the immediate past 4-H year, September 1 –August 31 and plans or goals related to information included in this application. Do not show your accumulated work from other project years in this report.

3. This application may be hand written, typed or completed on a computer. If you do not type, it is acceptable for someone else to type the form from a hand written version. We encourage you to make your application as legible as possible – we can’t evaluate what you have done if we can’t read your application.

4. This application should include 4-H and non-4-H activities and consists of two parts: the Summary of Accomplishments and your 4-H Story.

5. The application may be printed, typed or done on you r computer. However, do not use a type size smaller that 12pt. Times News Roman. All paper must be white and the standard 8-1/2” x 11” size. Margins should be a minimum of 1” on all four sides. A maximum of four pages (one side only) is allowed for the Summary of Accomplishments and maximum of two pages (one side only) is allowed for the 4-H Story. Either single or double spacing is appropriate. NO PERSONAL NAMES OR SOCIAL SECURITY NUMBERS should be included in or on the Summary of Accomplishments or the 4-H Story.

6. The Summary of Accomplishments (75 points) should relate to activities during the immediate past 4-H year and should include three sections:

• 4-H/Extension accomplishments in the Award area in which you are applying

• Additional 4-H/Extension Accomplishments

• Community/School/Other Accomplishments

7. The 4-H Story is worth 25 points. Your score will be added to your Summary of Accomplishments. The 4-H Story should relate to your 4-H activities in the specific award area in which you are applying and relate to your activities during the immediate past year only. Include specific experiences that you were not able to share in the Summary of Accomplishments.

8. The Summary of Accomplishments and the 4-H Story should be stapled separately. Staple the pages of each section /story with one staple in the upper left corner and paper clip your application to your award application cover sheet (the front of this form). Your final application can only include:

• Cover Sheet with personal information

• Summary of Accomplishments

✓ 4-H/Extension Accomplishments in Award Area for immediate past year

✓ Additional 4-H /Extension Accomplishments for immediate past year

✓ Community/School/Other Accomplishments for immediate past year

• 4-H Story

9. This 4-H Award Application will be used to select winners for Peoria County 4-H Memorial Awards and the 1sr Year Swine Award only. Members may apply for Memorial Awards each year they are enrolled in the award program areas. Members may only apply for the 1st year Swine Award the first year they are enrolled in the Swine project area.

Scoring the Peoria County 4-H Year Focus Award Application

The Peoria County 4-H Year Focus Award Application will be judged in the following manner:

1. The Summary of Accomplishments and 4-H Story will be scored. The maximum score possible is 100 points (75 points for the Summary and 25 points for the story). See scorecard below for point divisions by criteria.

2. The members top score from the Summary of Accomplishments and the 4-H Story will be added together to provide a total 4-H award application score.

3. Finalists will be ranked according to these scores. Members with top scores will be named winners. There will be one winner chosen in each award category.

Sample Award Application Score Card

|Criteria |Points |

|4-H/Extension Accomplishments in Award Area | |

|Size/Growth of Project – 7 points |30 |

|Knowledge & Skills Gained – 7 points | |

|Participation in Activities – 7 points | |

|Leadership Exhibited – 7 points | |

|Community Service – 2 points | |

|Additional 4-H/Extension Accomplishments | |

|Size/Growth of project – 4 points |20 |

|Knowledge & Skills Gained – 4 points | |

|Participation in Activities – 4 points | |

|Leadership Exhibited – 4 points | |

|Community Service – 4 points | |

|Community/School/Other Accomplishments | |

|Participation in Activities – 9 points |25 |

|Leadership Exhibited – 10 points | |

|Community Service/Citizenship – 6 points | |

|4-H Story | |

|Knowledge Gained in Award Area – 4 points |25 |

|Use of Knowledge Gained in Award Area – 6 points | |

|Impact of 4-H on Family & Personal Life – 6 points | |

|Ability to Communicate Ideas Effectively – 4 points | |

|Impact of 4-H on Future Plans – 2 points | |

|Organization, Neatness, Spelling, Punctuation – 3 points | |

|Total Score |100 |

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Fulton-Mason-Peoria-Tazewell Unit

COLLEGE OF AGRICULTURAL, CONSUMER & ENVIRONMENTAL SCIENCES

University of Illinois | U.S. Department of Agriculture | Local Extension Councils Cooperating

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