2014-2015 4-H Tropicana Public Speaking Contest
Enrollment Form
Please Fill Out Completely- ONE SHEET PER CLASSROOM
*Statistical information is needed for annual ES237 report sent to the State
4-H Office, University of Florida, Gainesville.
** All Information must be completed before material can be sent to you**
TEACHER INFORMATION
(ONLY IN THIS BOX)
Name of School Contact_______________________________________________________________
Teacher’s First Name________________________________ Last Name _______________________________
What is Your Ethnic Origin:
Hispanic________
Non-Hispanic ________
What is Your Race (check one):
White __________Black ________ Alaskan/Am. Ind._______
Asian __________Hawaiian/Pac. Island ________
School Name: ________________________________ E-Mail (important)_____________________________
Phone # ________________________________________ Fax # _____________________________________
** TOTAL # OF STUDENTS PER CLASSROOM
Number of Classrooms Participating 4th _________ 5th _________6th ________ Your Grade______________
Number of Males__________________ Number of Females______________ Combined Total_______________
Ethnic Origin: Number of Hispanic ____________ Number of Non-Hispanic _____________
Race: Number of White __________ Number of Black __________ Number of Alaskan/ Am. Ind. ____________
Number of Asian _________ Number of Hawaiian/ Pac. Island __________ Other ______________
DATE:____________________________ Number of Hours of Teaching___________________ Project:
WILL YOU NEED SCHOOL JUDGES?
Yes ______ No ______
Date of School Contest ___________________________________
PLEASE CHECK!
Have you fill out all of the information?
PLEASE FAX Completed form to:
Fax #: 407-850-5121
For further information please contact the office at: 407-254-9213
or orange4h@ifas.ufl.edu.
PU1