SAMPLE
REPORTING BACK: Report Form for National 4-H Conference Participants
Name
Chris Clover
County
Dane
For the period ending
July 31, 20 09
Please list your "Reporting Back" activities. Include all presentations, news articles, radio or television interviews, displays, events and
any other ways you share your National 4-H Conference experiences with others in your county, district and state. Reports are due
quarterly for one year after your return (July 31, Oct. 31, Jan. 31, and April 30). If additional space is needed, you may continue on
the back of this form or attach pertinent articles. Data is essential for planning of future programs. Thank you!
Date
Type & Size of Audience
Activity Description
Comments
2/1/08
General public (readership of local Article in local newspaper about the Many people have asked me about how I
paper)
upcoming trip and its purpose.
was selected for the trip since the article
was printed.
4/18/08
Staff, former Extension personnel, Submitted trip evaluation and article Focus of my article was on skills learned
public interested in UW-Extension for “Youth Line”.
and direction of 4-H as well as those
(mailed to several hundred people)
things I found surprising.
5/3/08
15 Verona High School Student Shared what I learned about working Students were interested in ways other
Council members and our adviser
with the national group at our monthly organizations handle tough issues and
meeting.
include all voices.
5/6/08
Verona Strivers 4-H club:
members and adult leaders
5/25/08
10 Dane
members
6/21/08
650 WI 4-H & Youth Conference Assisted other team members in The 2006 team did a good presentation. I
delegates and adult leaders
presenting to the assembly at the plan to use some of their ideas when I do
2006 WI 4-H Youth Conference
promotions at county/district levels.
Co.
Leaders
40 Gave a report about activities and The teens had many questions and
what I learned. Advised them to apply seemed very enthused. Adults were
for N. Conf. & other trips.
pleased to hear about the experience.
Board Thanked them for their support & The leaders wanted to know specifically
urged them to continue it. Gave a how I would use what I learned and
report about the conference.
offered some good ideas.
Due: July 31, Oct. 31, Jan. 31, and April 30
Wisconsin 4-H Outreach, 431 Lowell Hall, 610 Langdon St., Madison WI 53703-1195