Pike County Cooperative Extension -

4-H and Youth | 4-H Request Form

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"Bring the Fun of 4-H Learning to your Classroom!" Request Form

School:_____________________________________________________________________

Phone #: __________________________________ best time to call:____________________

Teacher:______________________________________________________

Grade/Subject:____________________# of Students: boys_____ girls_____

I would like the following programs:

1. Kids & Kash

7. Egg to Chick
Fall/Spring Sessions
Date requested:

2. Catch the Bug

8. Gee Whiz In Agriculture

3. Food, Land & People

9. Rockets Away

4. Wild Over Work "WOW"

10. Talking with TJ: Conflict Resolution

5. My Future Is What I Make It

11. Wildlife Is All Around

6. Get Ready, Get Set, Get A Job

12. Endangered Wildlife

Complete and print Request Form and Mail or Fax to:

Diane Boucher Appel
Pike County Cooperative Extension
514 Broad Street, Milford, PA 18337
Fax: 570-296-3406

Orders should be in my office two weeks before you plan to begin projects.

OR send an e-mail message to dba3@psu.edu. Copy this form and paste it into your e-mail message.

Penn State | College of Agricultural Sciences | Cooperative Extension & Outreach

This page last updated Wednesday, November 30, 2005

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Please e-mail us with your questions, comments or suggestions at PikeExt@psu.edu