In accordance
with state and federal guidelines, schools must enroll each year to
remain active in the 4-H Wildlife Stewards program. The 4-H enrollment
year begins October 1st. All schools must enroll by December 31st in
order to continue to receive information and support.
Please be
sure to fill in required areas (*).
Thank you!
GENERAL
INFORMATION
Name of School: *
Grades
Involved: *
(Check all that apply)
K-2
3-5
6-8
9-12
School
Address: *
City: *
Zip Code: *
County: *
Designated
Contact Name: *
Phone: *
Email: *
School
Website: *
School Residence:
Principal Name:
TEACHER PROFILE
*Indicate
the number of participating teachers in each category:
Caucasian
African
American
Hispanic
Asian
Native
American
Males
Females
STUDENT
PROFILE
*The
following section on classroom information must be filled out completely.
This information is needed for statistical reporting in compliance
with Federal Funding requirements. Racial data is required by Affirmative
Action Policy. All information is kept confidential.
GRADE
Classroom
Composition
K
1
2
3
4
5
6
7
8
9
10
11
12
Caucasian
(F)
(M)
African
American
(F)
(M)
Hispanic
(F)
(M)
American/
Alaskan Native
(F)
(M)
Asian
Pacific Islander
(F)
(M)
Totals
HABITAT EDUCATION
*Site
features completed or in progress. Please check all that apply:
Bird Garden
Dry
Stream Bed
Butterfly
Garden
Stream
Restoration
Vegetable
Garden
School
Nursery
Historical
Garden
Greenhouse
Woodlands
Worm
Composting
Wetlands
Nest
Boxes
Native
American Garden
Amphitheater
Garden
Pond
Learning
Shelter
Bioswales
Wheelchair
Accessible
PROJECT
HIGHLIGHTS
Tell
others about your project and what you are learning. Please limit
your entry to 250 words.
Would you be interested in participating in an on-line exchange
with other classrooms?
Yes
No
Share your
thoughts: How is your project helping students improve
their science skills? Please limit your entry to 250 words or
less.
LEVEL
OF PARTICIPATION
Indicate the average number of hours per month your average students
participate in these hands-on projects:
1-2 hours
3-6 hours
7-15 hours
more than
15 hours
Number
of Participating Volunteer Parents
who volunteer with the habitat education site:
FUNDING
SOURCES
Estimate the amount of funds you generated this year:
In-kind
donations
$
Grants
$
Sales/Fundraisers
$
Cash Donations
$
TOTAL
$
PARTNERS
Please list key organization and group partners who assisted with
this project such as community clubs, neighborhood associations,
community agencies, garden shops, etc.
Square Feet of Wildlife Habitat
Created and/or Maintained This year
