Evaluation Form Template—4th-12th Grades
page 1 of 3
http://www.exnet.iastate.edu/Pages/y4h/evaluation/
2008 Southwest Iowa Junior 4-H Camp Leadership Team
4-H Youth Program
Evaluation Form
We are interested in what you learned by being involved in 4-H.
Section I Life Skills
Please mark the box that indicates what you think about the following.
As a 4-H Camp Counselor I have learned…
yesalways
1. 2to use new information I have learned. (1008)
1. 2the importance of protecting the natural environment.
. (3034)
usually
5.
to be friends with people who are different from me. (6006)
12
6.
to contribute as a member of a team. (8007)
11
1
7.
to follow instructions as they are given to me. (8004)
10
1
to accept responsibility for doing a job. (8008)
NOTE: one person did not answer #7
8.
yes
no
12
4.
3.
nonever
12
to act in a responsible manner when using natural
resources. (3030)
to think about possible alternatives before making a
decision. (2003)
to value the contributions of others. (6003)
2.
not
often
12
12
10
2
12
Section II My 4-H Camp Counselor Experience
Please mark the box that indicates what you think about the following.
9.
Adults in the 4-H program know how to work with kids. (2103)
12
10.
4-H helps me prepare for the future. (2116)
12
11.
In 4-H I have opportunities to practice my leadership skills. (2118)
NOTE: one person did not answer #11
11
Section III Additional information
I have been in 4-H for __(9201)
(a) 1-2 years
(b) 3-4 years
(c) 5-7 years
1
(d) 8-10
10
I am ___ years old.
(i) 16
(j) 17
7
(a) 18
3
(b) 19
2
(9202)
I am entering grade ___.
(i) 10
(j) 11
(a) 12
7
(b) college
5
(9203)
NOTE: One person did not answer the years in 4-H questions
Iowa State University 4-H Youth Program – Patricia A. Hendricks
January 1999 (rev. 04-99)
D:\219510271.doc
Evaluation Form Template—4th-12th Grades
page 2 of 3
http://www.exnet.iastate.edu/Pages/y4h/evaluation/
I am _____.
9
3
(a)
(b)
(9204)
female
male
My residence during most of my I would describe myself as
4-H years is/was __. (9205)
___. (9206)
(a) farm
(a) Native American
8
(b) rural non-farm
(b) Asian American
1
(c) town under 50,000 pop.
(c) African American
3
(d) city over 50,000 pop.
(d) White/Caucasian
12
(e) Hispanic
(f) Racially mixed
Would you recommend 4-H to
a friend or family member?
(9207)
12
(a)
(b)
(c)
(d)
definitely would
probably would
probably not
definitely not
The most important thing I have gained from my 4-H Camp Counseling experience is
(9300)
-working with others
-all my campers! They were amazing! I already miss them. I’ve really been able to step forward and be
more of a leader.
-to compromise with a bunch of different campers so all are happy
-How to deal with kids who are all very different and also how to get to know people
-Friends & leadership skills
-My girls! Responsibility for others children and how important it is to set a good example!
-how to work with younger members and teach them new things
-learning how to work with kids who are different
-feeling confident that kids are relying on me to guide them and be their leader
-using leadership to keep things going but kept things exciting also using responsibility, trustworthiness
and organization
-confidence in my responsibility, communication & leadership skills
-working everyday with kids—that’s my important thing
The one thing I would change about the 4-H Camp Counseling program is
-more planning sessions
-screen the unknown counselors better to eliminate problems.
-try to do interviews on counselors before camp
-one more night for just counselors  More fun!
-NAP TIME!
-make counselor selecting more strict!
-Maybe one more planning session otherwise nothing
-nothing
-possibly just stay one more night & leave right away in the morning
-the cabins with people from all the same place/town
-nothing, it was really fun & organized
-I can’t imagine changing it Dave you have got it good
(9400)
Iowa State University 4-H Youth Program – Patricia A. Hendricks
January 1999 (rev. 04-99)
D:\219510271.doc
Evaluation Form Template—4th-12th Grades
page 3 of 3
http://www.exnet.iastate.edu/Pages/y4h/evaluation/
Other comments I would like to make
-It went smoothly. Everything flowed really well.
-mix up counties in cabins
-I love camp!
(9500)
-I love camp! It’s one of my favorite parts of summer!
-Thank you David & Jenny for everything you did!!
-Great job preparing us to be counselors & giving us responsibilities & thanks for trusting us so much!
-It was awesome!
-It’s going to be sad leaving, but I’m strongly considering applying for working here in the summer. I
really think it would be something right up my alley.
Name (optional):
Date:
County(ies):
Iowa State University 4-H Youth Program – Patricia A. Hendricks
January 1999 (rev. 04-99)
D:\219510271.doc