Record Book

California 4-H Record Book 2016-2017
California 4-H
Record Book Forms
For Junior, Intermediate, and Senior Members
2016 2017
These are the most current forms. Please discard all previous forms.
!
Revised June 30, 2016
Section 2: Personal Development Report

County: Fresno
Name of 4-H Club or Unit: Kingsburg 4-H
Program Year: 2015-16 Total Years in 4-H: 5
Name: Mason Norman Waldner
(Include years as a primary member)
Birth Date: 3/14/03

Age on December 31: 13
Grade in School: 8th
(of the program year listed above)
Address: 40845 RD 40
City: Dinuba State: California
Email: mrwaldbern@gmail.com
Zip: 93618
Phone: (559) 897-5330
Club Meetings Attended This Year

During the current year, 80% attendance is
required for any achievement rank
Do not include project meetings.
Meetings Held
Meetings
Attended
Hours
Attended
Percent Attended
10
10
20 hours
100%
I have personally prepared this report and believe it to be correct.

Members Signature:
Date:
I have personally reviewed this report and believe it to be correct.

Parent/Guardian Signature:
Date:
4-H Adult Partners Signature:
Date:
!
Star Ranking
Record what you accomplished during the year. To qualify for any of the achievement rank awards, you must attend
80 percent of both the local club and the project meetings held during the year. To obtain any of the ranks, you
must complete the asterisked (*) categories as a part of your total effort.
Bronze Star:
Complete at least 5 of the 8 categories listed.
Silver Star:
Gold Star:
Platinum Star:
Star Ranks are designed to encourage members to participate in a wide variety of activities over a number of years.
The bronze, silver, gold, and platinum stars build on past achievements.
Categories of Participation
Number of Different Categories Required
Total
Past
Years
Total
This
Year
Total All
Years
1. Projects Completed
2. Project Skill Activities
25
3. Events Attended
4. Leadership Development
Transfer credits from previous years to the column

headed Total From Past Years.
Bronze
5 Required
Silver
6 Required
Gold
7 Required
Platinum
7 Required
11
2*
4*
8*
12*
31
15
20
34
13
47
12
25
40
60
13
10
20
30*
40*
(0)
(0)
(2*)
(4*)
Significant Leadership Role

(requiring 20 hrs. or more of work)
5. Citizenship &
Community Service
15
21
10
20*
30*
40*
6. Communication Skills
22
11
33
12*
24*
36*
48*
14
23
(4*)
(7*)
(10*)
(15*)
7. Honors and Recognition
12
21
10
15
20
8. Healthy Lifestyle Activities
23
32
10
20
30
40
4-H Presentations
* Required for Star Rank

Numbers contained within parenthesis are included in the total category number (not an extra requirement).
!

Star Rank
4-H Member must be currently enrolled in the 4-H Youth Development Program.
Present Rank:
[ ] None
Rank Applying for: [ ] None
[ x ] Bronze
[ ] Silver
[ ] Gold
[ ] Platinum
[ ] Bronze
[ x ] Silver
[ ] Gold
[ ] Platinum
[ ] Approved [ ] Not Approved

4-H Club/Unit Leader's Signature
!
Date
1.
Projects Completed This Year

Star Requirements: Bronze 2, Silver 4, Gold 8, Platinum 12
Total Past Years:_____8____
Total This Year: _____3____
During the current year, 80% average attendance across all projects is
required for any achievement rank.
Meetings
Held
Total All Years:_____11___

Meetings
Attended
Total
Hours
Percent Attended
1. Lamb Project
12
82%
1. Outdoor Adventure
100%
1. Sewing
6.5
100%
16
13
22.5
TOTALS
AVERAGE
Include your specific involvement (attended, competed, presented) and the level of participation:
I = Individual, L = Local Club/Unit/Project, C = County/Area/District,
M = Multi-county/Section, S = State, N = National/Multi-State, G = Global
You may add lines or add a page for each category, if needed.
2.
Project Skill Activities

Total Past Years:______25___
Total This Year: ____6_____
Date
Hours
Level
Total All Years:___31_____
Activity Title & Brief Description
Location
4-H Project Skill Activities (Enrolled OR not enrolled in the project)
10-15-15
Judged Exhibit-Fresno Fair Showman Ship

Market Lamb
Fresno, CA
10-18-15
Barnyard Olympics
Fresno, CA
Judged Exhibit-Float Santa Lucia Parade
Kingsburg, CA
3-12-16
4-H Livestock Judging
Fresno, CA
5-7-16
Livestock Achievement
Reedley, CA
12-12-15
Project Skill Activities Outside of 4-H (List up to two significant project skill activities)
3-8-16
Filmed At County History Day
Tulare, CA
Total Number:
!
3.
4-H Events Attended

Date
Hours
10-15-15
8-15-15
9-19-15
Level
Event Title
Location
Attended Fresno Fair- Showed a lamb
Fresno, CA
Kingsburg 4-H Party
Kingsburg, CA
Fresno County 4-H Achievement Night
Fresno, CA
10-18-15
Barnyard Olympics
Fresno, CA
12-13-15
Christmas Caroling
Kingsburg, CA
12-7-15
Kingsburg 4-H Christmas Party
Kingsburg, CA
2-1-16
4-H Record book Meeting
Kingsburg, CA
3-12-16
Livestock Judging Day
Fresno, CA
4-2-16
Spaghetti Dinner
Kingsburg, CA
4-4-16
Spaghetti on a Board
Kingsburg, CA
5-7-16
Livestock- Lamb Achievement Test
Kingsburg, CA
3-19-16
Color Me Green Run
Fresno, CA
5-21-16
Club Book Sale Fundraiser
Kingsburg, CA
Total Number:
!
13

4.
Leadership Development
Total Past Years:____9_____
Total This Year: ___4______
*Required: Leadership Development Reports completed by intermediate and senior members

Total Past Years: ____ Total This Year: ____ Total All Years:____
Gold = 2 Platinum = 4
Met Requirement ___YES ___NO
Date
Hours
Level
Leadership Activity
Location
6-1-15
Sargent of Arms
Kingsburg, CA
8-15-15
Co-Chair 4-H Week Display
Kingsburg, CA
Leadership Training Day
Fowler, CA
12
Jr. Leader
Kingsburg, CA
8-22-15
Leadership Development Outside of 4-H (List up to two significant leadership activities)
Total Number:
Intermediate and senior level members must complete a Leadership Development Report for specific
roles. See the LDR instructions in the Record Book Manual for more details on this requirement.
!
5.
Citizenship & Community Service

Date
Total All Years:____21____
Hours
Level
*Citizenship Activity*
Location
10-17-15
Auction Runner @ Fresno Fair
Fresno, CA
11-18-16
Thanksgiving Bag Dispersal
Kingsburg, CA
3-6-16
Distributed & Collected Canned Goods
Kingsburg, CA
5-16
Petting Zoo@ Tractor Supply
Dinuba, CA
Citizenship/Community Service Outside of 4-H (List up to two significant citizenship activities)
6-16
Youth Volunteer-VBS-KCC
Kingsburg, CA
12-5-15
Played in Band for New London Event
Dinuba, CA
Total Number:
!
6. Communication Skills
Required: 4-H Presentations

Total Past Years: ___14_ Total This Year: __9__ Total All Years:__23__
Bronze = 4 Silver = 7 Gold = 10 Platinum = 15
Met Requirement ___YES ___NO
Date
Hours
Level
*Communication Activity*
Location
4-2-16
County Level 4-H Presentation Day
Fresno, CA
4-30-16
Regional Level 4-H Presentation Day
Fresno, CA
5-28-16
State Level 4-H Presentation Day
Davis, CA
10-6-15
Sheep Poster Presentation
Kingsburg, CA
4-17-16
4-H Presentation Practice
Kingsburg, CA
11-2-15
Outdoor Adventure Project Report
Kingsburg, CA
4-4-16
Color Me Green Report
Fresno, CA
5-2-16
4-H Presentation Day Report
Kingsburg, CA
5-2-16
Officer Election Speech
Kingsburg, CA
Communication Development Outside of 4-H (List up to two significant communication activities)
2-25-16
Science Fair School
Kingsburg, CA
3-5-16
Science Fair County
Tulare, Ca
Total Number:
!
11
7. Honors/Recognition
Date
Hours
Level
Honor or Recognition
Location
4-2-16
Gold Award for 4-H Demonstration County
4-30-16
Gold Award for 4-H Demonstration Sectional Fresno, CA
5-28-16
Gold Award for 4-H Demonstration State
Davis, CA
3-18-16
Livestock Judging 2nd in Age Division
Fresno, CA
4-5-16
Gold Award for Livestock Achievement Test
Kingsburg, CA
4-28-16
Gold Award for Field Livestock Achievement

Test
Reedley, CA
8-15
Club Gold Seal For Record Book
Kingsburg, CA
9-16-15
Sliver Star Pin for 100% Attendance
Kingsburg, CA
Fresno, CA
Honors and Recognition Outside of 4-H (List up to two significant honors)
3-16
Best Of Show Science Fair School Level
Kingsburg, CA
5-21-16
1st in Age Division Dala Horse Trot
Kingsburg, CA
Total Number:
!
8.
Healthy Lifestyle Activities

Date
Hours
Level
Activity or Organization
Location
15-16
Kings River Band
Kingsburg, CA
3-16
Kings River Baseball
Kingsburg, CA
2-16
Kings River School Science Fair
Kingsburg, CA
6-16
KCC-VBS Tech Leader
Kingsburg, CA
4-17-16
Getty Museum Field Trip
Los Angeles, CA
3-16
County Science Fair
Tulare, CA
3-8-16
County History Day Video Project
Tulare, CA
6-16
Kingsburg Seawolves Swim Team
Kingsburg, CA
5-21-16
Dala Horse Trot
Kingsburg, CA
Total Number:
!
Section 3:
My 4-H Story
Heres where youll put the My 4-H Story you write for this
year. Follow these word count minimums:
Junior (or first year member): 250 500 words
Intermediate: 500 1000 words
Senior: 1000 2000 words
Follow these formatting guidelines:
Double space.
Print single OR double sided, you choose.
Use an easy-to-read font such as Times New Roman or Garamond.
Keep the text size between 12 point and 14 point.
See page 17 of the Record Book Manual for more information.
This box is just a placeholder. Replace this page with your story
before submitting your book.
!
Section 4: Annual Project Report

Submit one form per project. You may add additional pages if needed.
Name
Program Year
Project
Years in Project
Number of project meetings held

Number of project meetings attended
% Attended
LEARNING EXPERIENCES
Explain what you did, what you learned, and the skills you gained in the project.
Include the level of participation: I = Individual, L = Local Club/Unit/Project, C = County/Area/District,
Date
Level
Hours
What did you do?| Where? | What did you learn or what skill did
you practice?
!
Number

List things made, raised,
List honors or awards earned.
grown, or improved.
List citizenship activities
List leadership development activities
Expenses and Income/Value

Summarize, totaling all expenses such as: ingredients, feed, vet supplies/visits, materials, exhibitor's fees, and all income
such as: value of finished products, animals sold, exhibit premiums, etc.
Item
Number
Totals
Income
or Value
Expense
$
Total Profit or Loss $

If another member was thinking about taking this project next year, what would you tell them
about what can be learned in this project?
!

4-H Members Signature:
Date:
I have personally reviewed this report and believe it to be correct.

Date:
Your
Expression Page
goes here!
Now is the time to get creative and teach the readers something
you learned in this project.
This box is just a placeholder. Replace this page with your own
expression page before submitting your book.
!
Section 5:
Collection of 4-H Work

Here you have space to show what youve done and learned
throughout the year by attaching photos, samples, and
examples. Aim for no more than 11 pages, please! (See the
Record Book Manual for more details about allowable pages.)
This box is just a placeholder. Replace this page with your own
Collection of 4-H Work before submitting your book.
!
Section 6: Leadership Development Report

Part 1 (Pre)
Completed by intermediate and senior members only
Name
Mason Norman Waldner
Club
Kingsburg 4-H
Program Year
2015-16
[]
Leadership Development Project
[x] Junior Leader
[] Teen Leader
[]
All Star/County Ambassador
[]
Club Officer
[] Exchange
[]
State Ambassador
[]
Camp Counselor
[] Other
Complete this page at the beginning of the program year:

Briefly describe your leadership roles marked above. Why are they important to you?
As a Junior Leader, I helped find a project to teach for the meetings and explain and
teach. I gathered the supplies and materials and set up for the meetings. This was
important to me because I learned how to organize and help run a project meeting. It
also was important to me because it also taught me how to teach people and give
consecutive comments.
I. Record the goals you have for your leadership development.

II. At the end of the program year, which of the 6 Cs (confidence, competence, character, caring,
connection, contribution) do you plan to have developed?
I hope I become a better leader in a way that I can run a meeting all by myself and able
to run a meeting efficiently covering all the steps and making sure everyone is caught
up and under standing the project. Confidence, Competence,Connection.
!

Part 1 (Post)
Complete this page at the end of the program year.
Through your leadership activities, what spark(s) did you identify? What did you do or practice
to improve your leadership skills? What did you learn about leadership?
I identified that I have a spark in videography and cinematic short films. I filmed for
my schools history day project. I learned how that it is important to have a script and
idea for every shot. I learned how to operate a camera and sound systems and the
video editor. I learned I wasnt organized enough and I didnt have great time
management.
Discuss the 6 Cs (confidence, competence, character, caring, connection, contribution) that you
developed this year. Which C(s) did you develop? How do you know that you grew in that C? If
you developed a C that you did not plan to, (Part 1) discuss that C as well.
I developed in confidence. I know I grew in that C because I participated in
presentation day. I developed confidence when I demonstrated in front of the judges
and made it all to state and got a gold award.
Final Signature
Members Signature:
Date:
!
!

Part 2 (Pre)
Complete one form, Part 2a and 2b per project or activity where you fill a significant leadership
role. You must complete this form for each significant leadership credit on your PDR.
Project/Activity
Outdoor Adventure
Years in Project/
Activity
Leader
Dan Waldner
Number of other
members
List 1 - 3 goals, strategies and shifting gears that apply to this project or activity. This page should
completed at the beginning of the program year.
Select Goals
Record the goals you have for this project or activity. Think of each goal as a destination.
1.I hope to become a better leader.
2.I hope to gain further teaching skills.
3.I hope to become more organized.
Pursue Strategies
What are the steps you will take to reach your goals? Include by when, by whom, and the specific actions
you will take.
1.I will help lead a large portion of the meetings.
2.I will be more involved in teaching lessons.
3.I hope to organize the meetings.
Shift Gears
What are some things that may get in the way of achieving your goals? What can you do to overcome
those challenges or obstacles?
1.School. I can try to help plan meetings around school and work when I am not doing school work
2.Outside of 4-H activities
3.
Reviewed and Discussed

Date:
I have personally reviewed and discussed this report with the member.
!

Date:

Part 2 (Post)
Reflect on the goals and strategies you set in Part 2a for each project or activity where you fill a
significant leadership role. Talk about what you did and what you learned to reach your goals. You
must complete this form as a companion to Part 2 (Pre) for each significant leadership credit on
your PDR.
Specific Goals
1.I hope to become a better leader.
2.I hope to gain further teaching skills.
3.I hope to become more organized.
Discuss how you did or did not reach your goals for this project/ program/ experience.
1.I reached my goal of becoming a better leader.
2.I reached my goal of gaining further teaching skills.
3.I reached my goal of becoming more organized.
What did you do to reach your goals? What strategies worked?
1.I set up the meetings.
2.I helped teach and lead the meetings.
3.I helped organize the supplies and materials
Give examples of when you had to shift gears toward reaching your goals.
1.
2.
3.
For the Adult Partner: Please provide feedback and comments on the 4-H members leadership
role.
Reviewed and Discussed

!

Date:
I have personally reviewed and discussed this report with the member.
Date:
!
Section 7: 4-H Resume

Completed by senior members only
First Name Last Name

Address, City, CA 9#### | (###) ### - ####| emailaddress@gmail.com
Personal Development Statement
One to three sentences that describe what you stand for and what you aspire to become as a human being.
It is not a statement of what you want to do, but rather how you want to be in the world.
Education and Professional Development
Name of School
Highest Year Completed to Date
Additional Course Work, Name of School or Organization
Leadership Skills
Position Title, Group or Program, Month/Year Started Month/Year Completed

Short description of what you did. Explanation of what you learned or skills you developed.
Citizenship Skills
Position Title, Group or Program, Month/Year Started Month/Year Completed

Short description of what you did. Explanation of what you learned or skills you developed.
Other Skills
These can include instruments, dance, sports, or other hobbies you have spent a significant amount of time
perfecting.
Certificates & Honors
List name of certificates and who issued it
!

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California 4-H Record Book 2016-2017

California 4-H Record Book 2016-2017

Section 2: Personal Development Report

(Include years as a primary member)

Birth Date: 3/14/03

Grade in School: 8th

(of the program year listed above)

Phone: (559) 897-5330

Club Meetings Attended This Year

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

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

4-H Adult Partners Signature:

California 4-H Record Book 2016-2017

Number of Different Categories Required

2. Project Skill Activities

Transfer credits from previous years to the column

Significant Leadership Role

7. Honors and Recognition

8. Healthy Lifestyle Activities

* Required for Star Rank

California 4-H Record Book 2016-2017

Rank Applying for: [ ] None

[ ] Approved [ ] Not Approved

California 4-H Record Book 2016-2017

Projects Completed This Year

Total All Years:_____11___

Project Skill Activities

Total All Years:___31_____

Activity Title & Brief Description

4-H Project Skill Activities (Enrolled OR not enrolled in the project)

Judged Exhibit-Fresno Fair Showman Ship

Judged Exhibit-Float Santa Lucia Parade

4-H Livestock Judging

Filmed At County History Day

California 4-H Record Book 2016-2017

4-H Events Attended

Total All Years:___47_____

Attended Fresno Fair- Showed a lamb

Kingsburg 4-H Party

Fresno County 4-H Achievement Night

Kingsburg 4-H Christmas Party

4-H Record book Meeting

Livestock Judging Day

Livestock- Lamb Achievement Test

Color Me Green Run

Club Book Sale Fundraiser

California 4-H Record Book 2016-2017

Total All Years:___12_____

*Required: Leadership Development Reports completed by intermediate and senior members

Co-Chair 4-H Week Display

Leadership Training Day

Leadership Development Outside of 4-H (List up to two significant leadership activities)

California 4-H Record Book 2016-2017

Citizenship & Community Service

Total All Years:____21____

Auction Runner @ Fresno Fair

Thanksgiving Bag Dispersal

Distributed & Collected Canned Goods

Petting Zoo@ Tractor Supply

Citizenship/Community Service Outside of 4-H (List up to two significant citizenship activities)

Played in Band for New London Event

California 4-H Record Book 2016-2017

Total All Years:____33____

Total All Years:___11_

Total All Years:_31___

Total All Years:_47___

Total All Years:_12___

Total All Years:21

Total All Years:33

Total All Years:_21___

Total All Years:32