Contact Name: ✻
Facility or Site Name ✻
County ✻
Facility/Site Physical Address ✻
Address 2 ✻
City ✻
State ✻
Zip Code ✻
Country ✻
Contact Phone Number ✻
Contact Email Address ✻
Please identify how your site would like to participate ✻
Please identify which resource(s) you are interested in ✻
Please identify the audience for the program/workshop (select all that apply) ✻
Date of potential workshop/program ✻
Time of potential workshop/program ✻
Number of youth participants for workshop/program ✻
Number of adult participants for workshop/program ✻
Complete the following questions only if a program/workshop is being requested
What are your goals for this program/workshop?
✻
What outcomes do you want met as a result of this program/workshop?
Identify any special needs or circumstances that may impact the delivery of the program/workshop
Does your organization have a facility where the program/workshop can take place? Please describe
For additional information contact:
Yolva Gil
4-H Youth Development Rep
Riverside County
ygil@ucanr.edu
(951) 683-6491 Et 227 - Riverside Office