REQUEST FOR OFFICIAL APPROVAL FOR ESTABLISHMENT OF 4-H CLUB Name of group: Type of 4-H group: (4-H club, 4-H special group, county 4-H leaders council, etc.) Purpose of group: To carry out a continuous 4-H club program serving the needs of youth in (City) providing them a variety of 4-H project learning opportunities. Including but not limited to: Volunteer leader or other person in charge of 4-H unit: (Signature) (Date) * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * OFFICIAL APPROVAL FOR 4-H UNIT On the basis of the above purpose(s), the (Name or type of group) is authorized to use the 4-H name and emblem in connection with it s programs and activities and is considered an official 4-H unit of the Mohave County Cooperative Extension. County 4-H Extension Agent s Signature Date Issued in furtherance of Cooperative Extension work, acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, Jeffrey C. Silvertooth, Associate Dean & Director, Economic Development & Extension, College of Agriculture and Life Sciences, The University of Arizona. The University of Arizona is an equal opportunity, affirmative action institution. The University prohibits discrimination in its programs and activities on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or genetic information and is committed to maintaining an environment free from sexual harassment and retaliation. C:\Users\Jamie Campbell\Documents\drupal\docs\club\RequestforOfficialApprovalForEstablishmentClub.wpd
EXPLANATION OF CLUB AND MEMBER COMPLETION REQUIREMENTS In order to give all members a quality 4-H educational experience the following requirements were established and approved by the Mohave County 4-H Leaders Council and Mohave Cooperative Extension. CLUB REQUIREMENTS: All 4-H clubs in Mohave County must have at least five (5) members enrolled to be approved. If for some reason the minimum of five members cannot be reached, because of geographic location, etc., and all reasonable efforts have been made to publicize the 4-H club, the leader may make a written request to Leaders Council for an exemption stating reasons for less than five members. MEMBER REQUIREMENTS: In order to remain a MEMBER IN GOOD STANDING 4-H members must complete the following requirements. 1. 75% attendance at the club level. A certain amount of flexibility should be given by leaders for members with illness or other reasons beyond their control. Members could be asked to make up meetings by doing extra work, report on meetings subjects or extra demonstrations, etc. 2. Demonstration given on the club or county level. Demonstrations are an important part of 4-H and teaches members to organize their thoughts and speak in front of a group. Demonstrations should be used at all meetings. This could be as informal as a show and tell or as formal as a 15 minute presentation. Leader s Guides to 4-H Demonstrations are available at the office. 3. Participation in at least ONE county event prior to County Fair. Participation in County 4-H events contribute greatly to the growth of the 4-H member. Many county activities and events are held each year including; small animal showmanship and judging clinic/contest, three county horse shows gymkhanas, favorite food show, home economics judging, demonstration day, county 4-H challenge, livestock judging events, county 4-H camp, and others may be announced throughout the 4-H year. 4. Exhibit in each project to be completed. Members are to exhibit at least one article in each project. Exhibit can be either a completed project item or educational poster illustrating what the member has learned in the project. 5. Submit completed and up-to-date Record Book at the end of the 4-H year. Record keeping is an important part of 4-H and is a skill that will help all members well into adulthood; with balancing checkbooks, bankbooks and filing income tax returns. Record books can either be submitted to club leaders or the 4-H office at the end of the 4-H year for county medal judging. For more information regarding club and member requirements, contact the 4-H Office at 753-3788. C:\Users\Jamie Campbell\Documents\ExplanationOfClubAndMemberCompletionRequirements.wpd
MOHAVE COUNTY 4-H MEMBERSHIP REQUIREMENTS Membership is open to all youth without regard to race, color, national origin, sex, disability, sexual orientation, genetic information, religion, political affiliation or socioeconomic backgrounds. 4-H Cloverbuds ages 5 8 years old 4-H Members ages 9 19 years old Prior to January 1st and not 19 years of age by January 1st of the 4-H Club year in which they enroll. A 4-H year is from October 1st-September 30th. Members must complete the following requirements in order to remain a Member in Good Standing. 1. 75% attendance at club level 2. Demonstration given on the Club or County level 3. Participate in at least ONE County event prior to the County Fair 4. Exhibit in EACH project to be completed 5. Submit a completed and up-to-date Record Book at the end of the 4-H year. 4-H Program Development Fee - is $15.00 per member, no matter how many clubs they belong to. This fee is used to purchase club insurance for all members in Mohave County. From this membership fee $5.00 will be available to the club to order project literature from either Arizona curriculum or National 4-H supply. Program Support Fee Multiple Club release form is for members in more than one club. Fill out as many as a member needs, they will use them to give to the other club leaders in lieu of the $15.00. Make Checks payable to: University of Arizona I give permission for my (son or daughter) to participate in the Mohave County 4-H Program and it s activities. I have read and understand the above Member Completion Requirements. By signing below you indicate it is also understood that ALL 4-H Events are Tobacco and Alcohol free. SIGNATURE OF YOUTH (If youth is a Clover Kid, signature is not required) NAME OF 4-H CLUB ENROLLING IN: SIGNATURE OF PARENT/LEGAL GUARDIAN PLEASE PRINT NEATLY YOUTH S NAME HERE ALSO: (Signature acknowledges that the youth is enrolled in 4-H) DATE D A T E MOHAVE COUNTY 4-H MEMBERSHIP REQUIREMENTS Membership is open to all youth without regard to race, color, national origin, sex, disability, sexual orientation, genetic information, religion, political affiliation or socioeconomic backgrounds. 4-H Cloverbuds ages 5 8 years old 4-H Members ages 9 19 years old Prior to January 1st and not 19 years of age by January 1st of the 4-H Club year in which they enroll. A 4-H year is from October 1st-September 30th. Members must complete the following requirements in order to remain a Member in Good Standing. 1. 75% attendance at club level 2. Demonstration given on the Club or County level 3. Participate in at least ONE County event prior to the County Fair 4. Exhibit in EACH project to be completed 5. Submit a completed and up-to-date Record Book at the end of the 4-H year. 4-H Program Development Fee - is $15.00 per member, no matter how many clubs they belong to. This fee is used to purchase club insurance for all members in Mohave County. From this membership fee $5.00 will be available to the club to order project literature from either Arizona curriculum or National 4-H supply. Program Support Fee Multiple Club release form is for members in more than one club. Fill out as many as a member needs, they will use them to give to the other club leaders in lieu of the $15.00. Make Checks payable to: University of Arizona I give permission for my (son or daughter) to participate in the Mohave County 4-H Program and it s activities. I have read and understand the above Member Completion Requirements. By signing below you indicate it is also understood that ALL 4-H Events are Tobacco and Alcohol free. SIGNATURE OF YOUTH (If youth is a Clover Kid, signature is not required) NAME OF 4-H CLUB ENROLLING IN: SIGNATURE OF PARENT/LEGAL GUARDIAN PLEASE PRINT NEATLY YOUTH S NAME HERE ALSO: (Signature acknowledges that the youth is enrolled in 4-H) DATE D A T E
Club/Unit Name Arizona 4-H Member Summary Form cx, Page of Club/Unit Leader Name Fill in the name of each member enrolling, and write in the paid column, cash(if paid cash) or write the Check 4* (if paid by check), or if no payment is collected attach a Multi Club Form(Other Club) and then check the appropriate box regarding rocjram Support Fees (PSF). Name Program Support Fee Paid Other club Name Program Support Fee Paid Other club 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 19 40 Total # Paid X $15.00 amount enclosed. Total Other Form Make check Payable to: The University of Arizona Club/Unit Leader Signature Date The University of Arizona college of Agriculture ~nd Life sciences is an equal opportunity, affirmative action Institution. The University does not discriminate on the basis of color, religion, sex, national odgin~ age, disability, veteran status, or sexual orientation in its programs and activities. race, CM-myrufPEnrolbnint&wn,y FonPi~eClub.y.pd
CLUB/UNIT ID: CLUB/UNIT NAME: THE UNIVERSITY OF ARIZONA COOPERATIVE EXTENSION 4-H CLUB/UNIT ENROLLMENT INFORMATION FORM (FOR OFFICE USE ONLY) CLUB/UNIT KEY LEADER NAME: IS THIS COMMUNITY RACIALLY MIXED? DELIVERY MODE (FOR OFFICE USE ONLY IS THIS CLUB INTEGRATED? (Y or N) (Y or N) If the community is racially mixed and the club/unit is not integrated, an AAP-2 form must be attached WHEN DOES THE CLUB MEET (DATE or DAY(s) & TIME)? WHERE DOES THE CLUB MEET (Physical Address)? DOES THIS CLUB/UNIT CARRY SUPPLEMENTAL MEDICAL (ACCIDENT) INSURANCE FOR MEMBERS? Y LEADERS? Y IF YES, WHICH COMPANY AMERICAN INCOME LIFE (Y or N) (Y or N) EMAIL CONTACT FOR THE CLUB: If the Key Leader does not have e-mail please provide the name and email of another volunteer, parent, or teen leader that is willing to distribute communications to club leaders and members. NAME: EMAIL ADDRESS: CLUB OFFICERS: President Other Vice-President Other Secretary Other Treasurer Other Reporter Other Historian Other WHAT IS THE TERM OF OFFICE FOR THESE OFFICERS? CLUB/UNIT FINANCIAL INFORMATION Where is the Club/Unit s checking/savings account? List the Employer Identification Number on the account. List the signers on the account(s) Who has the checkbook? Who receives the monthly statements? I certify that this club is open to youth without regard to race, color, sex, disability, or national origin. CLUB/UNIT KEY LEADER SIGNATURE DAT E Page 1 of 2 - Club/Unit Enrollment Information Form C:\Users\Jamie Campbell\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\CC83VDVF\4H ClubUnitEnroll_InfoForm.wpd
PLEASE LIST THE PROJECTS OFFERED BY THIS CLUB WITH THE PROJECT LEADER FOR EACH. PROJECT CODE PROJECT NAME PROJECT LEADER If more than one Project Leader list Coordinating Leader I have read the instructions for 4-H Volunteers regarding Compliance to Title VI of the Civil Rights Act of 1964 and certify that this club is open to youth without regard to race, color, sex, disability or national origin. CLUB/UNIT KEY LEADER SIGNATURE CLUB/UNIT PRESIDENT SIGNATURE DAT E DAT E Issued in furtherance of Cooperative Extension work, acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, Jeffrey C. Silvertooth, Associate Dean & Director, Economic Development & Extension, College of Agriculture and Life Sciences, The University of Arizona. The University of Arizona is an equal opportunity, affirmative action institution. The University prohibits discrimination in its programs and activities on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or genetic information and is committed to maintaining an environment free from sexual harassment and retaliation. Persons with a disability may request reasonable accommodation, such as a sign language interpreter, by contacting us at (928)753-3788. Requests should be made as early as possible to allow time to arrange the accommodation. Page 2 of 2 - Club/Unit Enrollment Information Form C:\Users\Jamie Campbell\AppData\Local\Microsoft\Windows\INetCache\Content.Outlook\CC83VDVF\4H ClubUnitEnroll_InfoForm.wpd
GROUP SERVING ONE RACE AAP-2 This form is to be filled out ONLY by groups or clubs serving one race, yet existing in an area having more than one race in its population. The Civil Rights Act, Title VI, requires that Extension personnel, particularly 4-H Club Leaders, make every reasonable effort to encourage participation by other races. Reasonable effort would include: Advertising through the local paper, radio or TV so that all individuals learn about Extension programs and have an opportunity to participate. You should retain a copy of the newsletter, flyer or paper used to reach individuals for documentation purposes. You may also make personal visits or write personal letters of invitation. Any written material must clearly state that Extension programs are equal opportunity programs open to all individuals regardless of race, color, religion, sex, national origin, age, disability, veteran status, or sexual orientation. The following is to be filled out and sent to the County Extension Faculty member with the enrollment sheet for your club. 1. Name of Club 2. What are the geographic boundaries of area that your club serves? North South East West Other 3. Are there minority individuals residing in the area served by your club? Yes No 4. Were all potential members notified of the opportunity to participate? Yes No 5. Did you and/or your members make all reasonable efforts to contact minority individuals to invite them to participate? Yes No Please check which of the following efforts you used: all available mass media personal letters personal visits 6. Please indicate any additional efforts you have made to interest or enroll minority individuals. Date: Signature: Title: Issued in furtherance of Cooperative Extension work, acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, Jeffrey C. Silvertooth, Associate Dean & Director, Economic Developement & Extension, Cooperative Extension, College of Agriculture & Life Sciences, The University of Arizona. The University of Arizona is an equal opportunity, affirmative action institution. The University does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or sexual orientation in its programs and activities. 02/2013
ENROLLMENT SHEET AAP-3 Members of Extension Club Year 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12 13. 14. 15. NAME ADDRESS ZIP CODE PHONE Gender Racial-ethnic make-up of this club: An officer is requested to make an observed determination of the racial ethnic makeup of the club and enter the correct number in each blank: White not of Hispanic Origin Black not of Hispanic Origin American Indian or Alaskan Native Hispanic Asian or Pacific Islander I have read the Instruction for Clubs regarding compliance to Title VI of the Civil Rights Act of 1964 and certify that this club is open to individuals without regard to race, color, religion, sex, national origin, age, disability, veteran status, or sexual orientation. Officer s Signature Office Date Issued in furtherance of Cooperative Extension work, acts of May 8 and June 30, 1914, in cooperation with the U.S. Department of Agriculture, Jeffrey C. Silvertooth, Associate Dean & Director, Economic Developement & Extension, Cooperative Extension, College of Agriculture & Life Sciences, The University of Arizona. The University of Arizona is an equal opportunity, affirmative action institution. The University does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or sexual orientation in its programs and activities. 02/2013
4-H Club ATTENDANCE RECORD YEAR 20 Name January February March April May June July August September October November December C:\Users\Jeanette\Documents\4-H\Forms\4-H Club\AttendanceRecordForTheYear.wpd
MOHAVE COUNTY 4-H CLUB MEETING/EVENT NOTIFICATION FORM In order for volunteers to be covered by University liability insurance, all meetings and events must be approved by the Extension Agent(s) PRIOR to the event. DATE(S) MEETING/EVENT DESCRIPTION LOCATION EVENT LEADERS/COORDINATORS, ETC. June 12 Clover Club Foods Project meeting (EXAMPLE) Jane Smith s house Jane Smith & Sally White nd 2 Tues., monthly Clover Club Community Club Meeting (EXAMPLE) Clover Community Center Jim Jones Submitted by 4-H Leader: Phone Number: Date: OFFICIAL USE ONLY: Approved by Mohave County 4-H Extension Agent Date: C:\1-mystuff\Enrollment\Meeting_EventNotification.wpd
4-H Club Planning Worksheet 20 Club: Leaders: Club Goals for the Year/Season 1.. 2.. 3.. 4.. 5.. MEETING DATE AND TIME WHAT TO DO AT THE MEETING WHO IS RESPONSIBLE WHAT TO DO BEFORE NEXT MEETING The University of Arizona College of Agriculture and Life Sciences is an equal opportunity, affirmative action Institution. The University does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or sexual orientation in its programs and activities.
4-H Club Planning Worksheet 20 MEETING DATE AND TIME WHAT TO DO AT THE MEETING WHO IS RESPONSIBLE WHAT TO DO BEFORE NEXT MEETING The University of Arizona College of Agriculture and Life Sciences is an equal opportunity, affirmative action Institution. The University does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, veteran status, or sexual orientation in its programs and activities.