2020 4-H School Enrichment Registration
Thank you for your interest in the 4-H School Enrichment Program. Please complete the following registration form for the sessions you wish to have brought to your classroom. We will invoice the school for payment in the spring. Please limit to three programs per teacher. We look forward to working with you and your students!
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Teacher Name *
Email Address *
School *
Grade *
Phone Number *
Best time to call *
Program Request #1 *
Program Request #1 Preferred Month *
Program Request #1 Preferred Method *
Program Request #2
Program Request #2 Preferred Month
Clear selection
Program Request #2 Preferred Method
Clear selection
Program Request #3
Program Request #3 Preferred Month
Clear selection
Program Request #3 Preferred Method
Clear selection
Total program cost *
Statistics
The following student statistics are needed for state reports. List number of students in each category who will participate in the programs.
Total number of students *
Number of Hispanic students *
Number of male students *
Number of female students *
Ethnicity: Number of White students *
Ethnicity: Number of Black students *
Ethnicity: Number of American Indian/Alaskan Native students *
Ethnicity: Number of Asian students *
Ethnicity: Number of Hawaiian/Pacific Islander students *
Residence: Number of students who live on a farm *
Residence: Number of students who live in a small town/rural community *
Residence: Number of students who live in a city *
Number of students in a 4-H Club *
Number of students not in a 4-H Club *
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