I have been in 4-H for (check one): ___1 – 2 years ___3 – 4 years ___ 5 years ___over 5 years
Circle your county: BELKNAP CARROLL CHESHIRE COÖS GRAFTON
HILLSBOROUGH MERRIMACK ROCKINGHAM STRAFFORD SULLIVAN
List all 4-H animal science project(s) you participate in during the 4-H year? ____________________________
__________________________________________________________________________________________
Please mark one box in each row
To use information to make decisions
To set goals for myself
To take responsibility for my actions
To listen well to others
To be respectful of others
To have the confidence to speak in front of groups
To work well with other youth
Always Usually
Sometimes Never
:
Please mark one box in each row
Learn more about my project
Work to achieve my project goals
Apply skills learned to future projects
Use information to make decisions about my project
Carefully listen and follow instructions
Recognize the value of being part of a team.
Clearly state my thought, feelings and ideas to other people
Value the contribution of others.
Meet new people.
Develop leadership skills as a result of my involvement
Work with a leader or mentor in my project.
Know what is required to be a successful contestant
Recognize the importance of education and learning
Be better prepared for my future
Increase your knowledge
Want to recommend 4-H to others
Always Usually
Sometimes Never
Does not apply

This survey is being completed at the _______________________ (name of event)
The most important thing I have learned at this event is:
__________________________________________________________________________________________
__________________________________________________________________________________________
Next year I would like to see __________________________________________________ at this event.
(Please continue below or on a separate piece of paper if needed)
The following questions are optional; please leave any blank that you prefer not to answer:
Are you a: ___ Male ___Female I am _____years old (as of January 1 st of the current year)
How are you involved in 4-H? (check all that apply)
 4-H club
 4-H Afterschool program

Special Interest (SPIN) or short term group
Which of the following best describes your race? (Check each box that applies to you.)

Native American or Alaskan Native

Asian
 Black or African American
 Native Hawaiian/ Pacific Islander
 White
Which of the following best describes your ethnicity? (Check one box.)
 Hispanic or Latino
 Not Hispanic or Latino
Which of the following best describes the primary place where you live? (Check one box.)

Farm

Rural (non-farm residence, population less than 10,000)

Town or city (population 10,000-50,000)

Suburb of city (population more than 50,000)

City (population over 50,000)
UNH Cooperative Extension is an equal opportunity educator and employer.
University of New Hampshire, U.S. Dept. of Agriculture and N.H. counties cooperating. 12/14/15