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Maine 4-H Cloverbud Record SheetName:County:Your Picture(Optional)Total Years in 4-H:Age on December 31:Club Meetings Attended This Year80% attendance is requiredMeetingsHeldMeetingsHoursAttended AttendedPercentAttended4-H Club Name:4-H Club Name:4-H Club Name:I have personally prepared this report and believe it to be correct.4-H Member’s Signature:Date:I have personally reviewed this report and believe it to be correct.4-H Adult Partner’s Signature:Date:1
Section 1: My 4-H Club and EventsTell us about your 4-H Club! Write, draw, photograph, make a video.The name of my 4-H Club is:4-H meetings and events: (check off each item you completed) I attended a fairI attended 4-H club meetingsI attended Maine 4-H DaysI participated in a community service projectI attended a special event like June Jamboree, 4-H Fun Days, etc.I participated in a 4-H Promotional Event (tractor supply, etc.)I completed public speaking (demonstration, fair, county event)Other:Which event was your favorite? Write, draw, share a photograph, or make a video.My favorite event was:This event was my favorite because:2
Section 2: My 4-H ActivitiesTell us about your activities! Write, draw, photograph, or make a video.Members are not limited to four activities. Duplicate this page as neededThe name of my 4-H activity is:The name of my 4-H activity is:My favorite thing about this activity is:My favorite thing about this activity is:The name of my 4-H activity is:The name of my 4-H activity is:My favorite thing about this activity is:My favorite thing about this activity is:3
Section 3: My CommunityWhat do you care about?Something that I care a lot about is:That’s great that you care about something! Complete a community service activity for the topic you wrote above.The community service activity that I completed was:Congrats on making a difference! Fill in the boxes below (write or draw).I did a community service activity with others!Who we helped:What we did:When we did it:Where we did it:Why we did this:4
4-H Life Skills I used in my projects this year:This is the Life Skills Wheel, it’s how we connect the skills we learn through our projects asthey relate to the big picture of what 4-H is. For Cloverbuds, we want you to look at the big4 in the middle: Head, Heart, Hands, and Health. For now, that’s what we want you to focuson, but see all the amazing skills related just to that one H!Life Skills Wheel Source: Iowa State Extension5
4-H Thinking Hat1. On the left side of the hat write what is unique about using your head or hands in one of your 4-H activities.2. On the right side of the hat write what is unique about using health or heart in one of your 4-H activities.3. On the bottom of the hat write what they have in common.6
Rubric - Cloverbud Record Form - Club & County LevelIndicatorsEmergingDevelopingMy 4-H Cluband EventsMember meets one or fewer of thefollowing: Member knowsthe name of their4-H club. Member identifiesan activityparticipated in in4-H. Member identifieswhich 4-H eventwas their favorite.Member meets two or fewer of thefollowing: Member knowsthe name of their4-H club. Member identifiesa few activitiescompleted in 4H. Member identifieswhy a 4-H eventwas their favorite. Member knows thename of their 4-Hclub. Member identifiesseveral 4-H eventsand meetings. Member articulateswhy a 4-H eventwas their favorite. Member knows the nameof their 4-H club. Member identifies avariety of 4-H events andmeetings. Member identifiesfavorite event andconnects event to lifeskill demonstrated. Member shares few4-H activities and listsfavorite thing abouteach activity listed. Activity is noted forevery project enteredin a fair or publicdisplay. Member identifieshow they used 3 orfewer life skillsconnected to Head,Heart, Hands andHealth in 4-H. Member sharesmultiple 4-Hactivities anddescribes favoritething about eachactivity listed. Activity is noted forevery projectentered in a fair orpublic display. Member identifieshow they used lifeskills connected toHead, Heart, Handsand Health in 4-H. Member sharesnumerous 4-H activities,describes favorite thingabout each and connectsthem to life skills used inthe activity. Activity is noted forevery project entered in afair or public display Member explains howthey used life skillsconnected to Head,Heart, Hands and Healthin 4-H. Member may use moredetailed life skill languagein addition to Head,Heart, Hands and Health.My 4-HActivities Member sharesminimal 4-H activitiesand their favorite thingabout each activity. Member identifieshow they used 2 orfewer life skillsconnected to Head,Heart, Hands andHealth in 4-H.ProficientDistinguished7
My CommunityPresentation andPreliminaryInformation Member identifiescommunity serviceactivity completed. Member partiallyconnects who, what,when, where and whypieces of the activity.Record Form meets two or fewer ofthe following: Record Form ispartially completed by4-H member with helpfrom adult. Member followedsome directions andrecord book is partiallycomplete and incorrect order. Record book is legible. Member attended atleast 80% of clubmeetings. Member identifiescommunity serviceactivity completed. Member partiallyconnects who, what,when, where and whythe activity happened.Record Form meets three of thefollowing: Record Form ispartially completed by4-H member withsome help fromadult. Member followed alldirections and recordbook is complete andin correct order. Record book islegible Member attended atleast 80% of clubmeetings. Member identifiescommunity serviceactivity completed. Member is able toarticulate who,what, when, whereand why the activityhappened. Member identifiescommunity serviceactivity completed. Member is able toarticulate who, what,when, where and why theactivity happened. Member is able todescribe and makeconnections between theactivity with greater goodfor the community. Record Form iscompleted by 4-Hmember with somehelp from adult. Member followedall directions andrecord book iscomplete and incorrect order. Record book islegible andpresentationquality. Member attendedat least 80% of clubmeetings. Record Form iscompleted by 4-Hmember with little to nohelp from adult. Member followed alldirections and recordbook is complete and incorrect order. Record book is legibleand presentation quality. Member attended 100%of club meetings.8
Rubric – 4-H Thinking Hat tinguishedHead or HandsMember meets one or fewer of thefollowing: Describes how heador hands quadrant isunique. Describes what theskill has in common.Member meets two of the following: Describes how heador hands quadrant isunique. Describes what theskill has in common. Uses detail todescribe how heador hands is unique. Uses detail todescribe what theskills have incommon. Uses detail to describehow head or hands isunique. Uses detail to describewhat the skills have incommon. Is able to makeconnections to bothskills.Heart or HealthMember meets one or fewer of thefollowing: Describes how heador hands quadrant isunique. Describes what theskill has in common.Member meets two of the following: Describes how heador hands quadrant isunique. Describes what theskill has in common. Uses detail todescribe how heador hands is unique. Uses detail todescribe what theskills have incommon. Uses detail to describehow head or hands isunique. Uses detail to describewhat the skills have incommon. Is able to makeconnections to bothskills.9
Cloverbud Form - Feedback Sheet4-H Member:Check which level is demonstrated in the project record form. There are NO scores for Cloverbuds.IndicatorsEmergingDeveloping Proficient DistinguishedMy 4-H Club and EventsMy 4-H ActivitiesMy CommunityMy Life SkillsPresentation and PreliminaryInformationEvaluators Comments:Section 1: My 4-H Club and EventsSection 2: My 4-H ActivitiesSection 3: My CommunitySection 4: My Life SkillsPresentation and Preliminary InformationEvaluator Initials:10
Record book is legible and presentation quality. Member attended at least 80% of club meetings. completed by 4-H member with little to no help from adult. Member followed all directions and record book is complete and in correct order. Record book is legible and presentation quality.
