Military Teens Engaged in Service Through Technology

2012 M.T.E.S.T.

Military Teens Engaged in Service through Technology

21-24 June 2012 (Arrive Thursday 6:30 PM until Depart Sunday 12:00 PM)

Cost is $15.00 per person. Deadline for registration: 8 June 2012 by 5:00 PM

(Please Type or Print)

Name:

First Middle Last Preferred Name for Nametag

Mailing Address:

City: State: Zip:

Phone: Email:

Include Area Code

Date of Birth: Age: County:______

Military Branch Affiliation: Air Force Army Coast Guard Marine Corps Navy Air Force Reserve

Air National Guard Army National Guard Army Reserve Coast Guard Reserve

Marine Forces Reserve Navy Reserve Other: ______

Demographic Info

Collected in compliance with federal requirements intended to ensure equitable program administration and availability

Gender: Male Female Grade in School: Are you a military dependent? Yes No

Race or Ethnicity: White or Caucasian Black or African-American Asian

(check all that apply) Native American or Alaskan Native Native Hawaiian or Pacific Islander

Hispanic or Latino Other (Please explain: )

Place of Residence: Farm Town under 10,000 or rural non-farm Town of 10,000 – 50,000

(check one) Suburb of City of 50,000 or more City over 50,000

Special Needs

Dietary Needs: Vegetarian (eat eggs, dairy) Vegan (no eggs, dairy, animal products of any kind)

Other diet restrictions (Please explain: ______)

Please describe any other special needs or accommodations that may be required to enable you to participate in this program:

Yes, I understand that compliance with the NC 4-H Code of Conduct and Disciplinary Procedure (http://www.nc4h.org/procedures_and_guidelines/index.html ) is a condition of participation in 4-H events.

The following forms must be presented during check-in on 21 June: 1) Code of Conduct; 2) Medical Release; and 3) Media Release in order to participate in the SOMK event. Refer to your http://www.nc4h.org/procedures_and_guidelines/index.html for the forms.

Name of Parent/Guardian: Contact #

Name of 4-H Professional Contact #

Mail registration form with check made payable to NC 4-H Club Account to:

J. Scott Enroughty

Department of 4-H Youth Development

NCSU Box 7606

Raleigh, NC 27695-7606

Questions? Contact Scott Enroughty, 919.515.8500 or

Speak Out for Military Kids (SOMK)

Ø  SOMK is a youth –led, adult supported project that generates community awareness of issues faced by youth of military families.

Ø  Through simulations, interviews, and research, citizens begin to understand what military families go through during deployment.

Ø  Youth acquire knowledge and skills in developing creative and informative presentations using a variety of different media

Ø  Youth form speakers bureaus and develop presentations, public service announcements, videos, and other materials and actively seek opportunities to share their experiences with others in the community (e.g. school assemblies, Service club meetings and events, city council meetings, fairs, community activities, and teacher in-service programs).

Ø  Youth gain leadership, research, organization, & public speaking skills