4-H Club Interest Survey

Name __________________________________________________________________

Age ___________  School Grade ____________________________________________

Address_________________________________________________________________

City__________________________ State ___________   Zip  _____________________

Phone ________________________  Email Address______________________________

Father's Occupation ________________________________________________________

Mother's Occupation _______________________________________________________

4-H is a national youth program of the Cooperative Extension Service. 4-H is for all boys and girls, ages 8 to 19, regardless of socio-economic level, race, color, religion, or national origin. Each member selects and completes one or more projects per year. The members elect their own club officers who preside at the monthly club meetings. Each member selects and finances his/her own project.

Examples of projects are clothing (sewing), foods and nutrition, pets, vegetable garden, health, rockets, computers, electric, small engines, outdoor study, safety, child care, photography and livestock. Projects are designed so that members "learn by doing."

Do you think you would be interested in joining a 4-H club if one is organized in your community?

____ YES      ____ NO

To the parents or guardians:

Were you ever a 4-H club member? (mother) ____________________________________

If yes, where? ____________________________________________________________

Were you ever a 4-H club member? (father) _____________________________________

If yes, where? ____________________________________________________________

Would you help with a group of boys and girls in a 4-H club? (mother) __________________

Would you help with a group of boys and girls in a 4-H club? (father) ___________________

Parent/Guardian Signature ___________________________________________________

(Please return to your teacher tomorrow)