Online Survey Software | Qualtrics Survey Solutions

For what school district and campus do you intend to apply?

School District

Campus

What County is your school district in?

County

Please enter the first name and last name of the principal that will host your program.

First Name

Last Name

What is the principal's email address?

Email Address

What is the best telephone number to reach the principal?

Daytime Telephone Number

Please indicate which grades you are targeting.

Please indicate the projected number of youth participating:

Please indicate the following:

Please indicate the following:

Please indicate which 4-H curriculum your school/campus would be interested in:

If you selected Other 4-H curriculum, please specify below:

Please fill in any additional information you would like for us to know, including other projects and/or activities you are interested in:.