4-H Golden Clover Award Application (formerly 4-H Award of Excellence)

The 4-H Golden Clover Award Application

(formerly the 4-H Award of Excellence)

Name (Please Print ) __________________________________________________ AGE __________________

(First)(Middle)(Last)

Parish ______________________________________________School _______________________________

Address ________________________________________ Parent’s Name ______________________________

All items are optional, but a total of 250 points must be earned for award. Points are accumulated based on your total years of work in
4-H.

The basic requirements are as follows:
1.Must be 14 years or under by January 1 of the club year application is made.
2.Must have at least two (2) years of 4-H club work, including award year.
3.Must score at least 250 points on the application scorecard.
4.This award can only be won by the 4-H member one time.

ACTIVITY

NUMBER

POINTS PER NUMBER

MAXIMUM PTS.

PTS. EARNED

Number of years as a 4-H Club member including this year. (20 points for two years and 5 points for each additional year.)

10/5

25

Held a 4-H Office in your local club

List offices held

1._________________________

2._________________________

5

10

4-H Project records (completed all activities in project book and submit to parish).

1._________________________

2._________________________

3._________________________

4._________________________

5

20

Competed in State 4-H Records

15

15


Workshops/clinics

1._________________________

2._________________________

3._________________________

4._________________________

5._________________________

6._________________________

7._________________________

8._________________________

9._________________________

10._________________________

5

50

Number of years participated in Parish Achievement Day/Contest Day/ Parish Fun Day/Parish Awards Day

10

40

Quality 4-H project exhibits or presentations

Year

Event

Project

Placing

(5 points for each 1st-3rd place won)

5

40

4-H Summer Camp/Challenge Camp or other Project related camps

Camp NameYear

  • _________________________________
  • _________________________________
  • _________________________________
  • _________________________________

5

20


State and district events (Such as Regional Cookery, 4-H Day at the Capital, Ag Awareness, etc.)

Event

Year

10

60

Help given on behalf of 4-H

Year

What

For Whom

How Many

3

30

Local 4-H club activities such as Safety, Community Drives, Citizenship activities, etc.

Year

Activity

3

30

TOTAL POINTS AVAILABLE

350

TOTAL POINTS EARNED

(MUST BE 250 OR MORE)

_______

This award can only be won by the 4-H member one time.

I have personally prepared this report and believe it to be correct.

______________________________________________________

(Signature of Club Member)

I have reviewed this report and believe it to be correct.

_____________________________________________________

Signature of Parent or Guardian)

1/10/2019 2:47:19 PM
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