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This section contains most of the vital information that we must know about each 4-H member or volunteer.

1. Club: Fill in the name of the club that the member/volunteer will be joining. If the member/volunteer will not be joining a club but working independently, fill in "independent".

2. Category: Circle "M-Member", "C-Cloverbud/Mini 4-H", "G-Organizational Leader", "A-Activity Leader", "R-Resource Leader", "S-Special", or "P-Project Leader"; which ever is appropriate for the member/volunteer.

3. Enrollment Type: If the member/volunteer is enrolling in the Chenango County 4-H program for the first time, circle "N-New Enrollment". If the member/volunteer has been enrolled in the Chenango County 4-H program in the past, circle "R-Re-Enrollment".

4. Name/Address: Be sure name and address of member/volunteer is filled in completely.

5. School: Indicate the school in which the member is enrolled. If the member is home schooled, fill in "Home School". Some times we may want to send out mailings to attendees of a certain school only. If we do not have your correct school you may be left out of these mailings and programs.

6. Social Security Number: This must be included on all member and volunteer Enrollment Forms. If we do not have your social security number on file you may not receive some benefits of being a 4-H member, such as fair premiums. Social Security Numbers are carefully protected and used with great discretion.

7. Year in 4-H: If you are enrolling in 4-H for the first time, fill in "1". If you have been enrolled in a 4-H program in the past, either in Chenango or another county, fill in the correct current numbered year of being a full 4-H member, not counting Cloverbud years. (For example, if you just moved to Chenango County and were involved in 4-H in another county for 2 years, you would fill in "3" because this is your 3rd year in 4-H.) If the member is 5-7 year old, they are considered a Cloverbud. Cloverbud years are indicated with a negative number. (-1 is first year Cloverbud; -2 is second year Cloverbud, etc.) If you are enrolling as a volunteer, do not count your years as a 4-H member when indicating your Year in 4-H.

8. Youth Leader: Place an "X" here if the member is going to be serving as a Teen Leader in their club. Be sure also to indicate which project area they will be a Teen Leader for under the projects section below.

9. Gender: Indicate a "F" for female or "M" for male

10. Birthday: Fill in the correct birth date of the member/volunteer. Our computer program will use this date to compute your 4-H age. Again, many times we send out mailings and open programs to certain ages only. If we do not have your correct birth date you may be left out of these mailings and programs.

11. 4-H Age: Your 4-H age is determined as of January 1st of the current 4-H year

12. Grade: Fill in the correct grade or home-school equivalent of the member. Yet again, many times we send out mailings and open programs to certain grade levels only. If we do not have your correct grade you may be left out of these mailings and programs. This space should be filled with your grade level number, "Post HS Education", "Not in School", "Special", or "None".

13. Other 4-H Memberships: If the member/volunteer is enrolled in another 4-H club in Chenango County, place the name of that club(s) here.

14. E-mail: It is time for 4-H to become technology savvy. We would like to do more with emailing to 4-H members and volunteers, but we can't without your help and email address. Many times we would like to send out a quick meeting reminder, ask a broad group for your opinion, or inform you of an upcoming event and it may be easier and more timely to do so by email than regular mail. If you have email and check it on a regular basis, please let us know. We promise to fill your e-mailbox with useful information only!

15. Leader Type: Most volunteers will circle "Direct Leader".

16. Ethnic: Please circle the correct ethnicity of the member/volunteer. This information is used for statistical reporting only. Cornell Cooperative Extension does not discriminate and provides equal program opportunities.

17. Residence: Please circle the correct category. All Chenango County residents will circle either "Farm" or "Rural Under 10,000.

Projects Section
It is important that this area is completely filled out as well. We need to know what projects you think you would like to participate in during the current 4-H year. If you are not positive what you are going to do, list all project areas that you think you would like to explore. For reporting and statistics purposes, it is important that we know who is doing work in each project area. Also, we often send mailings to only those that are enrolled in a specific project area. If we do not know what projects you are interested in, you may miss out on some important and interesting mailings. The pink "Chenango County 4-H Project Area Titles and Codes" list will be helpful in completing this section.

18. Project Name: Please list all projects that you are interested in participating in or that you would like mailings about during the current 4-H year. Project names can be found on the pink "Chenango County 4-H Project Area Titles and Codes" list.

19. Project Code: Please fill in the code that corresponds with the project area that you entered in the previous column. These codes can be found on the pink "Chenango County 4-H Project Area Titles and Codes" list.

20. Youth Leader: If you indicated that you will be a Youth Leader in your club at the top of this form, circle "yes" for each of the project areas that you will be a Teen Leader for. Circle "no" if you are not a Teen Leader for this project area.

21. Year in Project: New members/volunteer will indicate "1" in this column for each project area. If you have been involved in 4-H in the past, this number should reflect the number of years that you have participated in this specific project area. (For example: if you have previously been involved in this 4-H project area for 3 years, indicate 4 because this will be your 4th year in this project area. If you have previously been involved in 4-H for 3 years, but have never participated in this project area before, indicate 1 because this will be your 1st year in this project area.)

Signature Section
22. Disabilities: If the member/volunteer has any physical or learning disabilities that you want us to be aware of, please list them here. This information will be kept confidential and will only be used when appropriate to better administer a program or evaluation process to this individual.

23. Member Signature, Leader Signature, Parent Guardian Signature, Date: All 3 signatures and the date must be included for your Enrollment Form to be considered complete. Independent Members may leave the Leader Signature line blank. Volunteers may leave the Parent Guardian Signature line blank.

BACK
This information is used when generating mailing labels and other important reports for our use in the 4-H office.

24. Member/Volunteer Name: Fill in the same information that was placed on the member/volunteer name lines on the front side of the Enrollment Form.

25. Parent 1 Information: Fill in this section with the primary parental household at which mailings should be sent to the member. If both parents live in the same household, indicate both names on the appropriate line. Volunteers should indicate their own information here, as they are considered their own parent in our reporting system.

26. Parent 2 Information: Fill out this section if there is a second parental household that we should be aware of. This space is usually only filled in if the member's parents live in different households. You may also fill this space in with information for a grandparent or neighbor, etc., that is going to be working closely with the member on their 4-H project(s).

27. Parent 3 Information: This space should only be filled in if there is a grandparent or neighbor, etc., that is going to be working closely with the member on their 4-H project(s) that was not listed in the Parent 2 Information.