Personal Page
YEAR ____ to ____

Name	___________________________________________ Birth Date   _______________
Club	___________________________________________ This is my ______ year in 4-H
Extension
Unit	___________________________________________________________________
Address	_______________________________ City ___________________ Zip __________
Parent’s or Guardian’s Name _____________________________________________________
School You Attend   ______________________________ Grade or Year __________________
I live on a farm       ;   in town (under 10,000)      ;   in a city (10,000-50,000)       ;
	in the country, but not on a farm       ;    in a suburb or city over 50,000      . 

Phone ________________ E-mail  ___________________________

Projects in which you are enrolled this year:  _________________
_____________________________________________________
_____________________________________________________
_____________________________________________________			Put
_____________________________________________________		         Your
_____________________________________________________		       Picture
_____________________________________________________		         Here
_____________________________________________________
_____________________________________________________
_____________________________________________________

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

Date ______________ Signed  _______________________________________________
								4-H Member
Approved:
Date  _____________ Signed  ________________________________________________
							Parent or Guardian
Date _____________ Signed  _________________________________________________
						Community or Local 4-H Leader

A Personal Page should be filled out each year you are in 4-H and kept with your other 4-H records.
4-H STORY

Tell what you have done in 4-H during the past year that has seemed most important to you. Give some details about your projects—some difficulties you had, some of the most important things you learned. Tell how you helped your club, what you did to help others, how you helped at 4-H events. Tell how 4-H has helped you and your family. If you are under 14 years of age, write your story on this page. Use additional pages of white paper if necessary. Put it near the front of your 4-H record. 

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.