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Georgia 4-H at Camp Jekyll: Environmental Education

ES 237 Form

Please find a printable version here: 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 ________________

Check One: □ Public School         □ Private School            □ Homeschool

**The USDA has decided upon the following classifications for Race.  Please report the number of each race in the boxes below for both 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.

Grade Level # of People
Pre-K – 3  
4  
5  
6  
7  
8  
9  
10  
11  
12  
Adults  

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