MEMBER ACHIEVEMENT PLAN —9
Gold Guard Pin
Application form

Name _____________________________________________	Age ________        Years in 4-H _________

4-H Club ___________________________________________      County _____________________________

To receive the Gold Guard Pin, complete, during the current 4-H year, requirements 1-5 as listed below, and 16 of
the optional requirements.  (Exceptions are marked with **; these may have been done in previous years. Date must be noted.) Check in column at left when completed.  You may receive this pin only once, and you may receive only one Achievement Pin in a 4-H year.

______	1.	Exhibit one or more of your projects at a club tour, club exhibit day, the county fair, or an event
		similar to a county fair but with another title.

		Number of exhibits: _________	Event where exhibited: _________________________________

______	2.	Have received the Gold Pin. _______________________	Year received: __________________

______	3.	Enroll and participate in the Leadership project for the current year. 	

______	4.	Complete all your project records, project stories and photographs, personal page, 4-H story, and permanent record for every project you are enrolled in and turn it in to your 4-H leader.

______	5.	Be 15 years or older on January 1 of the current year.

OPTIONAL REQUIREMENTS FOR THE GOLD GUARD PIN

______	1.	Take part in the county 4-H Day as a contestant. Event: _______________________________________

______	2.	Take part in designated county quiz bowl or judging contests which are required for eligibility for county
		judging teams (you need not be named to a county team).
		
		Contests: ______________________________________________________Dates: _________________

______	3.	Take part in a county-wide event that is not already listed as a requirement.

		Event: ______________________________________________________________________________

______	4.	Serve as junior leader at county 4-H event, i.e. room monitor at 4-H Day, county fair, 4-H Day Camp, etc.

		Event: ______________________________________________________________________________

______	5.	Serve as an assistant to a project leader. Project: _____________________________________________

		Number of meetings: ________________________		Number of 4-H’ers: _________________

______	6.	Serve as a project leader (to be eligible for this requirement, your name must appear with the list of
		leaders your 4-H club sends to the county Extension Office).  Project: ___________________________

		Number of meetings: ____________________	Number of 4-H’ers: ________________________

______	7.	Serve as an officer in your 4-H club or group.**  Office: ______________________________________

______	8.	Serve as chair of a committee in your 4-H club. Committee: ___________________________________

_______	9.	Serve as a member of a county 4-H committee. Committee: ____________________________________
		
______	10.	Serve as a member of the County 4-H Council.** 

			Number of meetings attended: ______________________ 	Year: _______________________

______	11.	Take part in Regional 4-H Day as a contestant.** 

			Events: ________________________________________	Year: _______________________

______	12.	Participate in a state 4-H event such as Discovery Days, Ambassador Training, Citizenship In Action, 
			Kansas Youth Leadership Forum. **

			Event: ______________________________________________________________________________

______	13.	Serve as an officer in a county-wide 4-H organization or as a County Ambassador.**. 

			Organization/Office: _______________________________	Year: ________________________	

______	14.	Provide help to a new 4-H member throughout the year with projects, records, activities, etc.

			Name of member/describe assistance: _____________________________________________________

______	15.	Receive county recognition at the county achievement banquet or achievement night.

			Recognition received: __________________________________________________________________

______	16.	Make one or more public presentations of 4-H work to non 4-H groups such as schools, Family 
			Community Educators, service clubs (Lions, Kiwanis, Rotary), or make a radio or TV presentation
			featuring 4-H work.  Presentation/group: ___________________________________________________

______	17.	Take part in a state judging contest as a member of a county judging team.**

			Date: ___________________	Contest: _________________________________________________

______	18.	Assist in organizing a new 4-H club or group, a county-wide project or a special interest group, or a junior
			leader or older member organization.**

			Club or group: ________________________________________________________________________

______	19.	Teach at a state event such as Discovery Days, Photo Fun Day, etc. Event: _________________________

______	20.	Exhibit in a competitive class at a state or regional show such as the Kansas State Fair, Kansas All Breeds 
			Dairy Show, National Western Livestock Show, American Royal Livestock Show, Kansas Junior Livestock
			Show, or other similar shows.

		Fair/show: __________________	Exhibit: _________________________________________________

______	21.	Participate in a State Fair 4-H event such as: a demonstration contest, Fashion Revue, dog or horse show 
			(goes beyond just exhibiting at state fair).  Event: __________________________________________ -

______	22.	Serve on area or state 4-H committee. Committee: ____________________________________________

______	23.	Participate as a host or delegate in a recognized 4-H exchange trip or program with another county/district,
			state, or country.**

			Trip/program: ___________________________________________	Year: ______________________

______	24.	Serve as a counselor at 4-H camp, i.e., day camp or county 4-H camp.**

			Camp: _________________________________________________	Year: _____________________

_____	25.	Submit article, artwork, or photograph to the Kansas 4-H Foundation.**

			Item/date submitted: ___________________________________________________________________

______	26.	Act as a delegate to Citizenship Washington Focus in Washington DC.**  Date: ___________________

______	27.	Be named a state winner in a 4-H project or awards program.**

			Program: ______________________________________________	Year: _____________________

______	28.	Act as a delegate to the Kansas City 4-H Conference or the National Western 4-H Roundup in Denver.**

			Event: ________________________________________________	Year: _____________________

______	29.	Participate in a national 4-H event such as National 4-H Conference, 4-H Congress, or national 4-H 
			judging contests.**

			Event: _______________________________________________	Year: _____________________

______	30.	Help set up or clean up at a county event. Event: ____________________________________________

______	31.	Participate in a club or county 4-H fund-raiser. Level:_________________________________________
			
			Activity: ____________________________________________________________________________

______	32.	Participate in a club community service project.
	
			Describe participation: _________________________________________________________________

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

Signed: __________________________________________________________________________________________
4-H’er 								Date

Signed: ___________________________________________________________________________________________
Parent/Guardian 							Date

Recommended approval/deferral: _______________________________________________________________________
4-H Leader 				Date

Recommended approval/deferral: _______________________________________________________________________
4-H Leader 				Date

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Contents of this publication may be freely reproduced for educational purposes. All other rights reserved. In each case, credit
Kansas 4-H Member Achievement Plan 1, Kansas State University, June 2005.

Kansas State University Agricultural Experiment Station and Cooperative Extension Service

	Rice County, 2013

K-State Research and Extension is an equal opportunity provider and employer. Issued in furtherance of Cooperative Extension Work, Acts of May 8 and June 30, 1914, as amended. Kansas State University, County Extension Councils, Extension Districts, and United States Department of Agriculture Cooperating, 
John Floros, Director.