Louisiana 4-H Volunteer Reporting Form
Reporting Form for Continuing Education & Volunteer Service
Name: _________________________________________________________________
Telephone Number: (______) _________-____________
Title of Continuing Education:
o
Advanced Leadership Studies (MVP)
o
Outdoor Skills
o
Advisory Council Training
o
People Skills (MVP)
o
Business/Social Etiquette
o
Planning Educational Programs
o
Community Service-Learning (MVP)
o
Project Books/Cumulative Records
o
Development Stages (MVP)
o
Project Specific Curriculum Training
o
Diversity & Inclusion (MVP)
o
o
Recruiting New Members and/or
Volunteers
Essential Elements of Youth
Development (MVP)
o
o
Fundamentals of 4-H (MVP)
Risk Management I: Overnight
Chaperone (MVP)
o
Fundraising Fundamentals
o
Risk Management II: Controlling Risk
and Managing Liabilities (MVP)
o
Healthy Living
o
School Program/Club K-12th Grade
o
Horticulture
o
Teaching & Delivery Methods (MVP)
o
Judging in 4-H
o
Teambuilding
o
Leadership Basics (MVP)
o
o
Livestock
Understanding the LA 4-H Volunteer
Leader Association and its History
o
Marketing 4-H (MVP)
o
Volunteer Orientation
o
Officer Roles and Responsibilities
o
Working with Committees
o
Other
o
Youth/Adult Partnerships (MVP)
4-H Volunteer Report Form: Amended February 2010 (TAT, AC)
Page 1
Description of Educational Session:
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Date Completed: (month-day-year) ___________________________________________
(Select the date you completed your service. Please note that only submissions for the current year are acceptable)
Number of Continuing Education Hours: ________________
Mileage Driven: ________________
Unreimbursed Expenses: $________________
4-H Volunteer Report Form: Amended February 2010 (TAT, AC)
Page 2
Type of Service: Volunteer service
Activity:
o
Advisory Council
o
Livestock
o
Answer E-mail
o
Mass Media
o
Answer Telephone Calls
o
MVP Class Instruction & Organization
o
Civic and Community Service
o
MVP Parish Program
o
Committee Work
o
Newsletter
o
Continuing Education
o
Other
o
FNP/Jr. Master Gardener
o
Project Club Work
o
Fundraising Event
o
School Program/Club K-12th Grade
o
Group Presentation/Speakers Bureau
o
Service-Learning Event
o
Healthy Living
o
Tour
o
Home Visit
o
Website Maintenance
(Select the activity that you feel best matched your service. If you think that none of the activities on the list match your service, contact your local 4-H Agent,
and he/she will assist you in selecting the best activity to match your service)
Mode of Delivery:
o
Day Camping
o
Organized 4-H In-school Clubs
o
Individual Study/Mentoring
o
Overnight Camping
o
Instruction TV/Video
o
School Aged Child Care/Afterschool
o
Military 4-H Clubs
o
School Enrichment Program
o
Organized 4-H Community Clubs
o
Short Term/Special Interest
Date Completed: (month-day-year) ______________________________________________________________________
4-H Volunteer Report Form: Amended February 2010 (TAT, AC)
Page 3
Impact (Describe what happened to program participants as a result of your efforts. Brief Example:
Youth learned about hospital regulations and potential career choices when they visited the local
children’s hospital):
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Personal touch/impact story (Brief Example: Attending the service-learning program at the
Children’s Hospital with the parish teen club was an amazing experience. I feel as though I truly
bonded with the youth that attended, and that we truly brightened the day of the young people in the
hospital. It was incredible to watch the youth perform their planned duties and orchestrate the entire
experience):
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Total Number of People Reached: ________________________________________________________________________
Number of those who were Youth: _____________
Number of those who were Adults: _____________
Ethnic Groups of People Reached:
Number of African Americans
Number of Asians/Pacific Islanders
Number of Caucasians
Number of Hispanics
Number of Native Americans
Other
Total
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________
________
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________
Mileage Driven: ___________
Unreimbursed Expenses: ___________
4-H Volunteer Report Form: Amended February 2010 (TAT, AC)
Page 4