4-H School Enrichment Program Request

Teacher______________________________________________________________ Today's Date______________________
School, Group, Organization___________________________________________________________________________________________
Address___________________________________________________________________________________________________________
City________________________________________________________________ Phone____________________________
Audience Size_______________             Grade Level________________             Best time to call______________

 
PROGRAMS OFFERED
 

Date Required

  

Date Required
Ag In The Classroom

___________

 Aquatic Maistro ___________
    ___Two-Volume K-2   Wagon Masters ___________
    ___One-Volume 3-4   Meteorology  ___________ 
    ___One-Volume 5-6   I Am, I Can ___________
Are You Ready? ___________ Tornado Safety ___________
Entomology ___________ Oklahoma Aqua Times ___________
Blue Sky Below My Feet ___________ Plant Science ___________
Careful With Strangers ___________ Project L.E.A.D. ___________
Caring For Planet Earth ___________ Project Wet ___________
County  Government ___________ Pumpkin Project ___________
Emrbyology ___________ Talking With T.J. ___________

                   
PLEASE COMPLETE THIS INFORMATION FOR FEDERAL 4-H CIVIL RIGHTS REPORTS

            Number of students participating____________.  Totals for each item below should equal the number of your participating.
   

Place of Residence: Race and Sex:
________ Rural or Farm Female Male Total
________ Small Town (<10,000) Am. Indian/ ________ ________ ________
________ Large Town Alaskan Native
________ TOTAL Asian or ________ ________ ________
Pacific Islander
Age of Participants: Black ________ ________ ________
Female Male Total Hispanic ________ ________ ________
Under 5 ________ ________ ________ White ________ ________ ________
5 years ________ ________ ________ TOTAL ________ ________ ________
6 years ________ ________ ________
7 years ________ ________ ________
8 years ________ ________ ________
9 years ________ ________ ________ Please complete this request form and mail or fax by
10 years ________ ________ ________ October 1 to:
11 years ________ ________ ________
12 years ________ ________ ________ Gerri Ballard, Extension Educator4-H
13 years ________ ________ ________ Carter County OSU Extension
14 years ________ ________ ________ 107 First Street SW, Courthouse Annex
15 years ________ ________ ________ Ardmore, OK  73401
16 years ________ ________ ________ Fax:  (580) 226-3951
17 years ________ ________ ________
18 years ________ ________ ________
19 years ________ ________ ________ Submitted by:___________________________________

Back