Attachment 4
To accompany all survey questionnaires.
4-H Arts and Communications Program Evaluation
Consent Form
This questionnaire is part of an evaluation of the 4-H Arts and Communications Program,
a program of the University Of Wisconsin-Extension. The purpose of the evaluation is to
determine the nature of the 4-H Arts and Communication Program; the benefits it has for
youth participants, volunteers, and the community; and ways in which it is different than
other arts programs. 4-H managers will use the survey results to improve the program. If
you would like to see the results of this evaluation contact
Ellen Taylor-Powell, Ph.D., Evaluation Specialist
University of Wisconsin-Extension
432 N. Lake St., Room 609
Madison, WI 53706
608-262-2169
Your answers to the surveys are confidential. Your name never appears on the survey.
Only the evaluators ever see the surveys. Anyone may refuse to take the survey or may
refuse to answer any questions on the survey.
If you or your parents need more information on this survey or do not wish to be involved
please contact Ellen Taylor-Powell. Otherwise, we assume that your completed survey is
consent to participate at this stage.
A copy of the Human Subjects Protection Approval Form is on file in the UWEX Provost
and Vice Chancellor’s Office, 432 N. Lake Street, Room 521, Madison, WI 53706.