State Record Book Competition Cover Sheet

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Due Date: October 15, 2023 11:59 pm

First Name *

Last Name *

Email (that you or a parent/guardian frequently reviews) *

County *

Birthdate (month, day, year) *

Age on December 31, 2022 *

Total Years in 4-H *

Did your club meet regularly during the 2022-23 program year? *

Yes

Did your projects meet regularly during the 2022-23 program year? *

Yes

4-H Enrollment Status (check all that apply) *

Club

School Enrichment

Special Interest/Short Term

Individual Study

Overnight Camp

Day Camp (virtual or in-person)

Afterschool Child Care

Required

My initials here certify that my Record Book is an honest reflection of my own work. I have not copied what I learned from another person's book. (Copying date/time/location of meetings is okay.) *

My initials here certify that I understand that the content of my Record Book as submitted becomes the property of the University of California 4-H Youth Development Program and may be used in whole or in part for research, marketing and training. I understand that my name or other personally identifiable information will not be shared publicly and will remain confidential unless I give my written permission to share my first name only. *

If your book demonstrates an exceptional book and receives a high ranking Winner award, do you give the University of California 4-H Youth Development Program permission to post your Record Book on the State website as an example? If you agree, all of your personally identifiable information will be redacted (blacked out) before posting. *

Yes, I give permission for my redacted Record Book to be posted on the UC 4-H YDP website

No, my redacted Record Book may not be posted on the UC 4-H YDP website.

Special Accomodations: If needed, please describe any learning challenges that make it difficult for you to complete the Record Book on your own. Describe any special considerations you need in order for your book to be evaluated according to your abilities.

Please provide the url link(s) to a .pdf version of your Record Book from a shareable site. Please be sure to set your Record Book settings to viewable by all who have the link.

If you do not share a link, your book will not be evaluated. We will not follow up with you to ensure that you follow directions.

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