Arkansas 4-H Report Form
Before completing this form, please read ALL instructions. Please type or print.

Name
Project
Year
State Initiative (Check One)
Healthy Living: Mind	Community Action	Plants & Agriculture
Healthy Living: Body	Fine Arts	Environmental Science & Energy
Personal Development	Animal Science	Engineering & Technology
Number of years enrolled in the project
Number of years enrolled in 4-H
Name you want used in publicity
Name of 4-H club or group
Statement by Member
I personally certify that this report accurately reflects my work:
Date	Signature of 4-H Member

SECTION I. - PROJECT WORK

PROJECT GOALS

Using the state project objectives (refer to the Arkansas 4-H Projects and Objectives) for your project area as your guide. List your three top S.MA.R.T goals. (Remember they should be Specific, Measurable, Attainable, Relevant, Timely)

1. Example: I will compete in 4-H wildlife at District O’Rama in the summer and learn how to identify the common wetland ducks in Arkansas through studying for this contest.

2.

3.

KNOWLEDGE GAINED THIS YEAR

List the top three things you learned from participating in your projects.

1. Example: I competed in the 4-H wildlife contest at District O’Rama this summer and learned how to identify 5 different common Arkansas ducks including Mallard and Pintail

2.

3.

MAIN PROJECT WORK OVERVIEW

Describe all the things you have done in your main 4-H project. Use numbers if you can. Judges will be looking for three basic things: amount of project work; variety of project work and quality of project work.

Activity	2018	2019	2020	2021	2022

# Hours Worked	20	50	32	21	67

# Talks Given	1	3	5	7	12

(Instructions: Tabs have been set; margins have been set. Please use the tab button to move from the activity to the years. If you have questions, contact your local agent)

Educational Experiences in Your Main 4-H Project

This section is where you record activities you participated in and learned about your main project. List tours taken, talks or demonstrations seen or heard, individual instruction, exhibits, workshops, camps, competitions, consumer experiences (shopping), interviews made, websites visited, books and pamphlets read. Be sure to indicate level where educational experience took place (L=local/club, C=county, MC= multi-county, D=district, S=state, R=regional, N=national, I=international).

This page has been setup in 2 columns. Please type down the first column until you reach the end of the page and it will wrap you around into the next column. If you should need more than two columns, go to “Page Layout” tab then “Columns” and choose 3, do not use more than 3 columns. Remember that the judges want to be able to understand what you write. Avoid using abbreviations if possible. Delete instructions/examples.

Talks Heard (example)

12	C	Texting & Driving - example

Tours Taken (example)

C	Texting & Driving - example

Overview of other 4-H Project AND ACTIVITY EXPERIENCES

This page is to be used to report experiences in those projects and activities that are not reported on page 2. Report no more than three projects. Be sure to list the name of each project and then tell your activities. Use numbers if you can (# of animals, size of garden, etc.)

Other Project #1

Activity	2018	2019	2020	2021	2022

# Hours Worked (example)	20	50	32	21	67

# Talks Given (example)	1	3	5	7	12

Other Project #2

Activity	2018	2019	2020	2021	2022

# Hours Worked (example)	20	50	32	21	67

# Talks Given (example)	1	3	5	7	12

Other Project #3

Activity	2018	2019	2020	2021	2022

# Hours Worked (example)	20	50	32	21	67

# Talks Given (example)	1	3	5	7	12

(Instructions: Tabs have been set; margins have been set. Please use the tab button to move from the activity to the years. If you have questions, contact your local county agent)

F. EDUCATIONAL EXPERIENCES IN OTHER 4-H PROJECTS AND ACTIVITIES

This section is where you record activities you participated in and learned about your other project. List tours taken, talks or demonstrations seen or heard, individual instruction, exhibits, workshops, camps, competitions, consumer experiences (shopping), interviews made, websites visited, books and pamphlets read. Be sure to indicate level where educational experience took place (L=local/club; MC: multi-county; C=county; A=area; D=district; S=state, R=regional, N=national). List the name of each project and then the activities for that project.

This page has been setup in 2 columns. Please type down the first column until you reach the end of the page and it will wrap you around into the next column. If you should need more than two columns, go to “Page Layout” then “Columns” and choose 3. Do not use more than 3 columns. Remember that the judges want to be able to understand what you write. Avoid using abbreviations if possible. Delete these instructions & examples when you start!

OTHER PROJECT #1

Talks Heard (example)

12	C	Texting & Driving - example

Tours Taken (example)

OTHER PROJECT #2

Talks Heard (example)

Tours Taken (example)

OTHER PROJECT #3

Talks Heard (example)

12	C	Texting & Driving - example

Tours Taken (example)

sECTION II – Leadership

4-h LEADERSHIP EXPERIENCES

List your 4-H leadership experiences. Remember leadership is: planning, leading, teaching, conducting, organizing, coordination, directing, demonstrating, talks and demonstrations, etc. Do not repeat any information listed on any other page. Be sure to indicate level (L=local/club, C=county, MC= multi-county, D=district, S=state, R=regional, N=national, I=international). Place Use * to indicate leadership experiences that relate to your main project.

Group Presented	#

Year	Level	Activity	To	reached

2023	L	Led Pledges	4-H Club	30

2024	C	*Presented Talk on Texting & Driving	Kiwanis	15

Use the tab button to get to the year column and the tab again to get to the activity column.

4-h LEADERSHIP EXPERIENCES CONTINUED

Group Presented	#

Year	Level	Activity	To	reached

Use the tab button to get to the year column and the tab again to get to the activity column. Use the top half of the page to add to your leadership experiences from page 6!

B. 4-H ELECTED/APPOINTED LEADERSHIP

List 4-H Offices you have held and committees served on. Give your specific responsibility. Indicate level (L=local/club, C=county, MC= multi-county, D=district, S=state, R=regional, N=national, I=international).

Year	Level	Office or Committee	Responsibility

2008	L	Club President (Example)	Presided at 12 Club meetings

(This section should be about the bottom half the page.)

SECTION III - Community Service

4-H COMMUNITY SERVICE

List by year those activities you have done which have helped someone else (excluding family members). Include an * for activities relating to your main or other projects.

Year	What did you do	Number of hours or Items contributed

2023	Children’s Shelter (example)	Donated 5 pajamas

2023	*Cleaned show arena at fair	3 hours

4-H COMMUNITY SERVICE CONTINUED

Year	What did you do	Number of hours or Items contributed

2009	Children’s Shelter (example)	Donated 5 PJ’s

SECTION IV - Awards and 4-H Promotion

4-H AWARDS

List awards received in 4-H (including fairs). Include * for awards relating to main or other projects. Indicate level (L=local/club, C=county, MC= multi-county, D=district, S=state, R=regional, N=national, I=international).

Year	Level	Type of Award	For what received

2011	C	*Ribbon	1st Place Steer

4-H PROMOTION/MARKETING

List 4-H promotional activities. Do not report activities listed on any other page. Indicate level (L=local/club, C=county, MC= multi-county, D=district, S=state, R=regional, N=national, I=international).

Year	Level	What You Did

2011	L	Displayed project board at bank (example)

SECTION V – 4-H IMpact

In 100 words or less describe what difference 4-H has made in your life.

Section VI – 4-H Story

The 4-H Story can be a maximum of 5 pages.

Section VII – Pictures

There should be 4 pages of pictures. One page each for Main Project, Other Projects, Leadership, and Community Service. Clovers have been included as place holders. Please insert your own photos and format as needed. NOTE: If your main project is photography you can have an additional 10 pages for photos you have taken.

Main Project

Other Projects

Leadership

Community Service

Photography Project Photos

Only use these pages if your main project is photography.