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. 

Kansas State University Agricultural Experiment Station and Cooperative Extension Service 
New Personal Page 	October 2008 
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, Fred A. Cholick, Director.