MEMBER ACHIEVEMENT PLAN —3
Clover Pin
Application form

Name _____________________________________________	Age ________        Years in 4-H _________

4-H Club ___________________________________________      	County _____________________________

To receive the Clover Pin, complete, during the current 4-H year, requirements 1-4 as listed below, and 3 of the optional requirements.  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.	Attend a majority (more than half) of the regularly scheduled meetings of your 4-H club. If you have  
		joined your 4-H club this current year, the majority of meetings will be computed based upon
		the number of meetings remaining following your joining the club.	

		Number of meetings held: ________________	Number of meetings attended: ______________	

______	3.	Present a program number at a 4-H project meeting or at another 4-H club or group meeting.
		
		Presentation/title: __________________________________________	   Date: _______________

______	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.

OPTIONAL REQUIREMENTS FOR THE CLOVER PIN

______	1.	Serve on a committee in your 4-H club. Committee:_________________________________________

______	2.	Attend a 4-H day camp, the county 4-H camp, and/or other state or area 4-H camps.
		
		Camp: _____________________________________________________________________________

______	3.	Attend a county or club achievement program. Program: _____________________________________

______	4.	Take part in a club or county quiz bowl or judging contest. 

		Date: _________________	Contest: _______________________________________________

______	5.	Take part in the county 4-H Day as a contestant. Event: _______________________________________

______	6.	Take part in a county event that is not already listed as a requirement.

		Event: ______________________________________________________________________________

______	7.	Attend Regional 4-H Day, or a similar event, to encourage your club or members and/or as a contestant.

		Attended: ____________________________________________________________________________

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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nor is criticism implied of similar products not mentioned.

Publications from Kansas State University are available on the World Wide Web at: www.oznet.ksu.edu

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.