Texas 4h Group Enrollment Form
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1
2
34-H 1-5.061
7-09
18 USC 707
Texas 4-H Group Enrollment Form
Note: Please complete the volunteer information on the back side of this form.
County ________________________________________________________
School/Location _________________________________________________
Start Date _____________________
End Date _______________________
Volunteer/Teacher Name _________________________________________
Presenter
____________________________________
Number of Instructional Hours ____________________________________
(if different than teacher)
Project
_______________________________________________________________________________________________
(refer to the Texas 4-H Project List)
Distribution of Members: Totals in this section for grade, residence and racial groups should all be the same and should reflect only (new) members
for whom this is their first 4-H experience since September 1.
Grade Level
Number of youths from military families? ______________
Number of
Number of
Grade
Grade
participants
participants
Gender
K
8
Male
1
9
Female
2
10
Total
3
11
4
12
Leaders and Teachers: Use your best estimates.
5
12+
Ethnicity
Please indicate the race and ethnicity of participants.
6
Not in School
Non-Hispanic
Racial Groups
Hispanic
7
Special
(1) White only
Sub-Total
Sub-Total
(2) Black or African American only
Total
(3) American Indian or Alaska Native only
(4) Asian only
(5) Native Hawaiian/Other Pacific Islander
(6) White & Black or African American
For Office Use Only
(7) White & American Indian/Alaskan Native
(8) Black & American Indian/Alaskan Native
# of Units
(9) White & Asian
(10) Balance (other combinations)
Delivery Method (check one)
Total
c 4-H Special Interest/Short-Term Program
Total Hispanic + Non-Hispanic
c 4-H Overnight Camping Program
c 4-H Day Camping Program
c 4-H School Enrichment Program
Where do they live?
c 4-H Individual Study/Mentoring/Family Learning Program
Farm
c School-Aged Child Care Education Program
Rural (under 10,000)
c Instructional TV/Video Program
Town (10,000-50,000)
c Not Connected with Youth Group
Suburb of Cities (<50,000)
Central Cities (>50,000)
EFNEP Program
Yes
No
c
c
Total
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