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4H Wildlife Stewards
 
Bringing Science and Nature Together...one school at a time.


ANNUAL SCHOOL ENROLLMENT FORM

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        


     

MORE INFORMATION
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SITE MAP ~ PRIVACY POLICY ~ DISCLAIMER
4-H Wildlife Stewards, Sunnyside Environmental School, 3421 SE Salmon 1209,
Portland, OR 97214 - 503-916-6074, e-mail: wildifestewards@oregonstate.edu
Copyright 2002-2009. All Rights Reserved.