Evaluation Request Form

Evaluation Request Form

This form is not currently in use. The most current information on evaluation processes is in MyExtension at https://my.extension.iastate.edu/4-h-evaluation.
Name*

First NameLast Name
Position Title*

County Youth 4-H StaffYouth Field SpecialistState Program SpecialistOther
E-mail*
Your County*
Program Name

Building Blocks of LeadershipClover Cookie FactoryCrops Feed the WorldGrowing in the Garden Local Foods Healthy LivingHealthy Living Club ChallengeMindful TeenNational 4-H STEM ChallengeOn Their Own and OKRicochetSWITCHOther
Program Start Date*

MonthDayYear
Date
Program End Date*

MonthDayYear
Date
Please tell us the estimated attendance at this program. *
This can be a rough estimate. If you aren't sure please just list your best estimate.
What format(s) would you like your survey in?

Paper copyDigital Qualtrics with QR codeDigital Qualtrics with LinkSpanish
This program will be open to grades:

456789101112
Please include the following content blocks for my survey:*

4-H Experience (if all youth participating would consider themselves 4-H'ers)ArtsCollege and Career Readiness (grades 8-12 only)CommunicationsHealthy LivingSTEM--Engineering (grades 8-12 only)STEM--GeneralCivic EngagementLeadershipI'm unsure, please use objectives to assist (below)
Main Objectives of the Program
This section is ONLY necessary if you selected "I'm unsure" in the section above. We will use this information to help select the appropriate blocks for your survey.

How would you like "optional questions" handled?*

Please include all optional questions and I will edit if necessary.Please remove all optional questions.
Additional Questions or notes to our team
Do you have additional questions you'd like to have added to your survey? Do you have comments or questions for our team? Please enter that information here.