Please complete the following request form so that I can best serve your needs.
Contact Name: ✻
Facility or Site Name ✻
County ✻
Facility/Site Physical Address
Contact Phone Number ✻
Contact Email Address ✻
Please identify how your site would like to participate ✻
Please identify which resource(s) you are interested in ✻
Please identify the audience for the program/workshop (select all that apply) ✻
Date of potential workshop/program ✻
Time of potential workshop/program ✻
Number of youth participants for workshop/program ✻
Number of adult participants for workshop/program ✻
Complete the following questions only if a program/workshop is being requested
What are your goals for this program/workshop?
What outcomes do you want met as a result of this program/workshop?
Identify any special needs or circumstances that may impact the delivery of the program/workshop
Does your organization have a facility where the program/workshop can take place? Please describe
For additional information contact:
Russell Hill
4-H Youth Development Advisor
Madera, Mariposa and Merced Counties
rdhill@ucanr.edu
(209)385-7418 - Merced Office