Oregon 4-H Group Enrollment Form

For 4-H year 10/1/2014 – 9/30/2015

Program
Program Name and Activity
Description/4-H Project Area
Start Date / End Date
Club/Group / Delivery Mode / Special Interest/short Term
Main Presenter/ Teacher/Staff name / Overnight Camping
Location / Day Camping
Number of hours / School Enrichment
Number of youth from military families / Individual Study
After School

Youth Demographics

Gender Distribution
Gender (Duplicates are known current 4-H participants) / Total / Duplicates
Male
Female
Sub-Total
Total (Duplicates removed)
Racial Distribution Please remove known current 4-H participants (duplicates)
Please indicate the race and ethnicity of participants / Ethnicity
Racial Groups / Hispanic / Non-Hispanic
  1. White only

  1. Black or African American only

  1. American Indian/Alaska Native only

  1. Asian only

  1. Native Hawaiian/other Pacific Islander only

  1. Balance (does not fall in above categories or unknown)

Sub-Total
Total
Residence Distribution Please remove current 4-H participants (duplicates)
Where do the participants live? / number
Farm
Rural (under 10,000)
Town (10,000 – 50,000)
Suburb of Cities (less than 50,000)
Central Cities (Greater than 50,000)
Total
Grade Distribution Please remove current 4-H participants (duplicates)
Grade Level / Number of Participants / Grade Level / Number of Participants
K / 8
1 / 9
2 / 10
3 / 11
4 / 12
5 / Post High School
6 / Not in School
7 / Special Education
Sub-Total / Sub-Total
Total

Volunteer Distribution

Racial Distribution
New volunteers only / Adult volunteers / Youth Volunteers
Ethnicity / Ethnicity
Racial Groups / Hispanic / Non-Hispanic / Hispanic / Non-Hispanic
  1. White only

  1. Black or African American only

  1. American Indian/Alaska Native only

  1. Asian only

  1. Native Hawaiian/other Pacific Islander only

  1. Balance(does not fall in above categories or unknown)

Sub-Total
Total
Adult Classification Distribution
Classification of Volunteers –these could be teachers, or trained Extension volunteers. / Adult Volunteers
Male / Female
Direct – Volunteers who deliver extension programming via face to face contact.
Indirect – Volunteers who help with planning, preparation etc., without actual face -to -face contact with youth
Sub-Total
Total
Youth Classification Distribution
Classification of Volunteers / Youth Volunteers
Male / Female
Direct - Volunteers who deliver extension programming via face to face contact.
Indirect - Volunteers who help with planning, preparation etc., without actual face -to -face contact with youth
Sub-Total
Total
Training Distribution
Volunteers Trained Through 4-H (new Only) / Youth Volunteers / Adult Volunteers / Other Adults
  1. Leadership – topics relating to organizing, managing and teaching youth in a non-formal education setting

  1. Parenting – knowledge and skills relating to developmental and learning needs of children and youth

  1. Other – any training topic beyond the two listed above.