LOUISIANA 4-H RECORD SUMMARY FORM Name of project being ...

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LOUISIANA 4-H RECORD SUMMARY FORM
Name of project being reported ___________________________________________________________
Name _____________________________________________________ Boy _________ Girl_________
(Please supply complete name-first, middle and last name)
Parish ____________________ Home Address_______________________________________________
Telephone Numbers_________________________ Social Security Number_______________________
Date of Birth _________________________ Age January 1, this year ___________________________
Name of parent(s) or guardian(s)__________________________________________________________
4-H Club Name________________________________________________________________________
Grade ____________ School _________________________________ If graduated, give date ________
Other education Year _______________ Course of study ______________________________________
STATEMENT BY 4-H MEMBER
I personally have prepared this 4-H report and believe it to be correct.
Date ___________________, 20____
Signature of 4-H Member______________________________
APPROVAL OF THIS REPORT
We have reviewed this report and believe it to be correct:
Date ____________________, 20____
Date ____________________, 20____
Date ____________________, 20____
Signed:___________________________________________
(Parent or Guardian)
Signed:___________________________________________
(Local 4-H Leader)
Signed:___________________________________________
(Parish 4-H Agent)
The work reported in this entire form is limited to the past three (3) years in the project being reported. It must include the current year.
Type or print in black. Type may be no smaller than 12 spaces to an inch; no photocopy reductions. Avoid duplications by reporting
information in only one section. When the level of participation is requested, use the following codes: L-Local; P-Parish; S-State;
R-Regional; N-National.
DO NOT ADD PAGES OR ALTER THIS FORM

NAME OF PROJECT:
Use your project book record sheets and summarize work (number of animals, dishes, meals, articles made,
repairs, activities, etc.) If possible, show money earned, savings realized, profits and loses. Use a chart to
report activities that you do each year. Give totals where possible. (See attached examples.)

NAME OF PROJECT:
Use your project book record sheets and summarize work (number of animals, dishes, meals, articles made,
repairs, activities, etc.) If possible, show money earned, savings realized, profits and loses. Use a chart to
report activities that you do each year. Give totals where possible. (See attached examples.)
SUMMARY
Project Work 03-04 04-05 05-06 Total
Description of Activities

LEARNING EXPERIENCES
List your participation in demonstrations, talks, displays, exhibits, tours, judging events, radio & T.V.
appearances, new articles written, interviews, surveys, books or articles read, etc. Indicate the year, topic or
title, and level. List additional headings that relate to your project.

LEARNING EXPERIENCES
List your participation in demonstrations, talks, displays, exhibits, tours, judging events, radio & T.V.
appearances, new articles written, interviews, surveys, books or articles read, etc. Indicate the year, topic or
title, and level. List additional headings that relate to your project.
Demonstrations Attended:
Yr. Total L P D S R N
Contests:
Yr. Total L P D S R N
Displays and Exhibits
Yr. Total L P D S R N

4-H Leadership - (Volunteer and elected)
Leadership is taking the lead by giving direction, planning and organizing, either with others or individually.
Be specific about your responsibilities and use action words to describe what you did such as planned,
coordinated, taught, conducted, etc. Include all 4-H leadership for the last three (3) years. Place an asterisk (*)
next to those items that are related to the project being reported.
Year Activity & Specific Roles and Responsibilities Level/Number
Project Total L P D S R N Other Total L P D S R N____

COMMUNITY SERVICE/CITIZENSHIP
Include things you have done alone or with others to benefit those outside of 4-H such as at school, church,
your neighborhood, city/town, parish, etc. Include community service done in the last three (3) years. Place
asterisks (*) by those related to the project being reported.
Year
Community Service/Citizenship Activity & Your Specific Roles/Responsibilities
MAJOR HONORS AND RECOGNITION IN 4-H PROJECT BEING REPORTED
Year Type of Award For What Received Level/number

The Way To Assemble Your 4-H Record Book
Include material as follows:
1. Cover and Section Dividers - Use a standard Acco-type fastener in a stiff 8 ½ X 11" binder. Do not use a loose-leaf ring
binder. Section dividers are optional.
2. The Louisiana 4-H Report Form - Print or type in black. Type may not be smaller than 12 spaces to an inch. Information
organized in a logical sequence with no repetition. Report only the past three years of project work including the current
year. List only your most important 4-H experiences. Do not add additional pages.
3. Your 4-H Story - Your story is limited to six pages. Type double space or print in black on one side. Type may be no
smaller than 12 spaces per inch; no photocopy reductions. Use 8 ½ X 11" paper width 1 ½” margin on left and 1" margins at
top, bottom and right side of each page.
Your story will represent you to those who read it. It is like an interview of you in writing. Emphasize your personal growth
and development, and focus on the project in which you are submitting your records.
1. Plan your story in outline form. List five (5) or more major areas of your project work listed on page two of the
summary form. Leave space under each to list the skills you acquired and what you learned. Expand on facts and
figures by telling what your 4-H experience has meant to you, how it was developed or affected your confidence,
your attitude, etc. The story should not be a re-listing of year-by-year accomplishments reported in the record
summary.
2. Begin with a brief introduction of yourself and your family. Briefly highlight participation in other school, clubs,
special honors or academic awards. (½ - 3/4 page)
3. Follow with paragraphs on each area of project work listed in the outline in step A. (2 -3 pages)
4. Highlight other 4-H projects and activities. (½ - 3/4 page)
5. On the final pages tell how you have benefited from your 4-H experiences including Leadership and Community
Service and how they have contributed to your school, job or career plans. Explain how 4-H helped you become a
better leader and citizen and how 4-H has increased your interest and participation in community affairs and what
you have learned from team and group efforts. (1 - 1 ½ pages)
4. Project Photographs - Photographs are limited to three 8 ½ X 11" pages, one side of page only. Mount pictures with rubber
cement and describe in a caption what is taking place in the photographs. Photos should include leadership, citizenship and
project activities in the program/project area in which the book is being submitted. (EXCEPTION: Photography allows ten
additional pages of program photos.)
5. Current Year’s Record Sheet - Record sheets must be in members own handwriting. Include current year’s record sheet for
the project in which you are submitting your record. Participants in the Governor’s and Superintendent’s Awards or any
contests that does not have a specific project should include record sheets from the project that relates to the program.
To prepare a Record for Two Contests - Use a divider page with a tab to indicate where the second application begins. The
second application will be exactly like the first in form, with one exception: ONLY pages 1-3 of the Louisiana Report Form need to
be completed. The other pages of the form should be copied and placed here to complete this form for the second contest. The second
application will include its own separate report form, story, project pictures and project record. The leadership and citizenship in the
second project should be indicated with two (2) asterisks (**) on the copy of those pages.
Citizenship and Leadership Contests - Do not complete page 2. Judging of project work will be based on leadership on page 4 and
community service and citizenship on page 5. Disregard instruction to place an asterisk (*) for items relating to project being reported.

NAME OF PROJECT: Example - Photography
Use your project book record sheets and summarize work (number of animals, dishes, meals, articles
made, repairs, activities, etc.) If possible, show money earned, savings realized, profits and loses. Use a
chart to report activities that you do each year. Give totals where possible. (See attached examples.)
SUMMARY
Project Work 2001-02 2002-03 2003-04 Total
(Example) Photography
Photography Taken
4-H Events 59 65 82 206
Family & Personal 28 55 48 131
Other Clubs 20 43 93 156
Yearbooks 36 48 155 139
Published Photos
Local Newspaper 5 8 16 29
School Yearbook 3 2 5 10
Expenses
Film $49.50 $68.30 $76.75 $194.65
Miscellaneous $54.75 $82.05 $103.10 $239.90
Slide/Video Shows 1 1 2 4
Money Earned
Prizes $15.00 $10.00 $50.00 $75.00
Description of Activities listed above.
Photographs: Used in school, Girl Scouts and Beta Club scrapbooks; family albums; insurance purposes;
4-H Week display; Parish 4-H Expo; photo display on the “History of Louisiana 4-H Clubs” and displays
at three banks and four public libraries.
Published Photos: Submitted photos and wrote news articles on Marsh Maneuvers; Parish Junior Leader
trips to the State Legislative session; Washington-Focus and parish Achievement Day contests and
activities (4); and 4-H Community service projects (3).
Expenses: 35mm camera was a gift. Film and processing of photos for yearbooks were free. Purchased
plastic file and binder to file negatives; lens cleaner, air brush and lens paper to clean camera.
Slides/Video Shows: Slide shows include: “This is 4-H”; “Junior Leader Happenings”; 4-H Seafood
Cookery Contest; Marsh maneuvers. Video programs include: 4-h Achievement Day (edited and
produced 15 minutes program); Let’s Go To 4-H Camp (shot video); Parish 4-H Horse Show (taped,
produced and edited 10 minutes program).
Money Earned: Photos were entered at the Louisiana State Fair, Morning Advocate Favorite Picture
contest and St. Patrick Church Fair Photo Contest.

NAME OF PROJECT: Example - Food and Nutrition
Use your project book record sheets and summarize work (number of animals, dishes, meals, articles
made, repairs, activities, etc.) If possible, show money earned, savings realized, profits and loses. Use a
chart to report activities that you do each year. Give totals where possible. (See attached examples.)
SUMMARY
Project Work 2001-02 2002-03 2003-04 Total
DISHES PREPARED BY FOOD GUIDE PYRAMID
VEGETABLES
FRUITS
BREAD, CEREALS, PASTA & RICE
MILK, CHEESE, PASTA & RICE
MILK, CHEESE, YOGURT
MEAT, FISH, POULTRY, DRY
PEAS, EGGS & NUTS
MEALS PLANNED AND PREPARED
DISHES PLANNED AND PREPARED FOR
SPECIAL DIETS
SNACKS PLANNED AND PREPARED
MONEY SAVED WITH COUPONS
DESCRIPTION OF ACTIVITIES
FOOD SAFETY:
FITNESS ACTIVITIES:
SPECIAL DIETS:
RESEARCH PROJECTS:
CONSUMER ACTIVITIES:

LEARNING EXPERIENCES (EXAMPLE)
List your participation in demonstrations, talks, displays, exhibits, tours, judging events, radio & T.V.
appearances, new articles written, interviews, surveys, books or articles read, etc. Indicate the year, topic
or title, and level. List additional headings that relate to your project.
Demonstrations Attended:
Yr. Total L 3 P 2 D S 1 R N
01-02 Darkroom Technique L1, P1
02-03 Camera Aperture/Shutter Speeds P1
03-04 Cropping Picture L2
03-04 How To Develop B/W Film S1
Contests:
Yr. Total L P D S R N
Displays and Exhibits:
Yr. Total L P D S R N
4-H Leadership - (Volunteer and elected) (EXAMPLE)
Leadership is taking the lead by giving direction, planning and organizing, either with others or
individually. Be specific about your responsibilities and use action words to describe what you did such
as planned, coordinated, taught, conducted, etc. Include all 4-H leadership for the last three (3) years.
Place an asterisk (*) next to those items that are related to the project being reported.
Year Activity & Specific Roles and Responsibilities Level/Number
(Example) Conservation Project
99-00 *Organized 4-H Conservation Project Group; planned L7
and taught six lessons to elementary 4-H members
00-01 *Taught junior members about food for wildlife and P10
made bird feeders
01-02 *Recruited two members for Junior Leader Club P2
1-02 Local club secretary - Record minutes/maintain role L1
Project Total L 7 P 10 D S R N Other Total L P D S R N

COMMUNITY SERVICE/CITIZENSHIP (EXAMPLE)
Include things you have done alone or with others to benefit those outside of 4-H such as at school,
church, your neighborhood, city/town, parish, etc. Include community service done in the last three (3)
years. Place asterisks (*) by those related to the project being reported.
Year
Community Service/Citizenship Activity & Your Specific Roles/Responsibilities
(Example)
Foods & Nutrition
02-03 *Meals on Wheels - Delivered lunch to elderly.
03-04
Interviewed Mayor - Discussed community problems related to youth
Citizenship Washington Focus - completed Short Course
Adopted-A-Grandparent - Baked snacks, ran errands and visited “Grand-mom” Millie
weekly
MAJOR HONORS AND RECOGNITION IN 4-H PROJECT BEING REPORTED
Year Type of Award For What Received Level/number
SILVER TRAY SEAFOOD COOKERY Pl