4-H Monthly Reporting Form

Survey Owner: Forsyth County 4-H

4-H Club Leaders should complete the following survey by the 7th day of every month for the previous month.

1. Club Leader Name

2. Club Name:

3. Name of the program:

4. Date(s) of the program:

5. Please list your attendace at your meeting for each of the following questions: White Male

6. White Female

7. African-American Male

8. African-American Female

9. Hispanic Male

10. Hispanic Female

11. Asian Male

12. Asian Female

13. Indian Male

14. Indian Female

15. List Others:

16. List the Total Number of Combined Volunteer Hours for all volunteers (preparation, holding and cleaning up form the meeting, spent in training, traveling, etc.):

17. Total number of Community Service Hours (Number of youth and volunteers X the number of hours):

18. Number of Military Youth Involved:

19. Age of Military Youth:

20. List the number of youth in each Military Branch:
Army, Force, Guard, Reserves, Other

You are about to submit results for the following survey/test:

4-H Monthly Reporting Form

If this is correct, click the 'Submit' button below.

Please contact the owner, awbowman@ncsu.edu, of this survey if you have any questions or comments.
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