Quarterly Report Form

Ohio 4-H Shooting Sports Instructor Hours - Mileage Report

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You can fill in the information requested on the form below and click the submit button when finished and it will send to my e-mail address.

Quarter - Please check the appropriate box below

January - March April - June July - September October - December

Name: Date: Phone: Ext.

E-mail Address: County:

Teaching disciplines at your 4-H club(s)

4-H Club Name: Preparation Hours:

Mileage: Teaching Hours:

Teaching disciplines at adult leader workshops

Please check the appropriate box below

Spring Workshop Fall Workshop

Preparation Hours: Teaching Hours: Mileage:

Teaching disciplines at Ohio 4-H Shooting Education Camp

Preparation Hours: Teaching Hours: Mileage:

Teaching disciplines at Farm Science Review

Preparation Hours: Teaching Hours: Mileage:

Teaching disciplines, Judging at County and State Fairs or Other Events (Please Specify)

Event:

Preparation Hours: Teaching Hours: Mileage:

Thank you for sending this information, this will help in our data collecting process.

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Larry Harris

State Extension Program Coordinator, 4-H Shooting/Fishing Sports, 4-H Youth Development

Canter's Cave 4-H Camp, 1362 Caves Rd., Jackson, Ohio 45640

Phone 740.286.4058

Fax 740.286.8622

E-mail harris.870@osu.edu

All educational programs conducted by Ohio State University Extension are available to clientele on a nondiscriminatory basis without regard to race, color, creed, religion, sexual orientation, national origin, gender, age, disability or Vietnam-era veteran status.

Keith L. Smith, Associate Vice President for Ag. Admin. and Director, OSU Extension TDD No. 800-589-8292 (Ohio only) or 614-292-1868

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