2025-2026 Merced County Request for 4-H Program Fee Waiver/Reduction

Request for 4-H Program Fee Waiver/Reduction for Youth Members Only

Provisions will be made by the 4-H unit (e.g., club) or volunteer management organization (e.g., committee) to cover program fees for eligible youth who are unable to pay them. The parent/guardian of an eligible youth for which a program fee waiver or reduction is requested must complete and submit this form. If you have more than one child, please submit a form for each child.

If you have any questions, please contact Crystal Cortez, 4-H Program Coordinator, crdcortez@ucanr.edu.

✻ = Required

Youth Member Information

Youth First Name: ✻

Youth Last Name: ✻

Program Year ✻

4-H Unit: ✻

I am requesting a

(Note: this waiver/reduction covers the state/county 4-H program enrollment fee of $67 or a portion; volunteer management organization (e.g., committee) fees will be 100% waived but you will need to check with your 4-H Club if there are additional fees.) ✻

Waiver of the State/County 4-H Program Fee in Full. Reduction of the State/County 4-H Program Fee (indicate amount in the next question).

If you are requesting a reduction of the program fee, please indicate the percentage of the fee reduction (i.e., 20%, 50%, etc) or amount.

Eligibility

The 4-H Youth Development Program is open to participants, regardless of their ability to pay. Program fees will be waived or reduced for eligible youth. Parent/guardian may complete the Request for 4-H Program Fee Waiver/Reduction or contact the county 4-H office to discuss request and confirm local process.

To determine eligibility for a full waiver or reduction of the program fee, please indicate if: Annual household cash income is at or below $52,720. See Reference: https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines 2024-2025 Federal Poverty guidelines.

If yes, you are eligible to apply for a reduction or waiver of your 4-H program fees.

If your answer is NO, please contact your local club for further assistance. ✻

Yes No

Acknowledgment and Comments

Please enter Parent/Guardian first and last name to acknowledge electronically the statement, "I confirm the information in this application is TRUE, CORRECT, and COMPLETE." ✻

Parent/Guardian Phone #: ✻

Parent/Guardian Email: ✻

Comments or any additional information you would like to share.

The University of California Division of Agriculture & Natural Resources (UCANR) is an equal opportunity provider.