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Please complete the following information about yourself and the group/class that you will be using the curriculum with.  We do ask that once you have finished teaching and/or utilizing the curriculum to please send to your parish 4-H office (Louisiana) or to the Louisiana 4-H State 4-H Office (out of state) a completed Louisiana 4-H Group Enrollment Form.
Please select your primary role for using a LA 4-H School Enrichment curriculum. *
 
Grade level(s) that you will potentially reach with the LA 4-H school enrichment program(s) taught. Select all that apply. *
 
Please list the percentage of male students and female students (based on total number of students entered) that you are EXPECTING to reach with the program below.
Gender must equal 100%
0
Please complete the PROJECTED PERCENTAGE of student ethnicities (based on total number of students entered above) to be reached below.  Type 0 for any options that do not apply for your students.
Gender must equal 100%
0
Please complete the PROJECTED PERCENTAGE of student races (based on total number of students entered above) to be reached using the form below.  Type 0 for any options that do not apply for your students.
Gender must equal 100%
0
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