Jekyll Island 4-H Center: Environmental Education

ES 237 Form

Thank you for returning this completed form to the Lead Staff Member or Program Coordinator. The information is required for the Federal Government.

School Name ________________________

Dates Attending ________________

**The USDA has decided upon the following classifications for Race. You may select all that apply for adults and students.

Race	Male	Female
White
African American or Black
American Indian or Native Alaskan
Asian
Native Hawaiian or Pacific Islander

ETHNICITY: In addition to Race, you may also check Hispanic or Latino.

	Male	Female
Hispanic / Latino

*PLEASE NOTE* - These totals may not match group totals if for example a student is classified as both “White” and “Hispanic.”

Please report the number of students from each grade and the number of adults on your trip.