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Spring 2024 4-H STEM Ambassador Host Site Request
If you are having difficulties completing this form, email
4-HScience@maine.edu
.
YES! I am interested in hosting a 4-H STEM Ambassador!
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* Indicates required question
Email
*
Your email
Program or Site/School Name
*
Your answer
Primary contact person:
*
Your answer
Phone/Cell (in case we have an emergency or need to reach you for some reason)
*
Your answer
Address (this is where materials will need to be shipped/delivered to):
*
Your answer
Secondary Contact:
Your answer
Secondary/Alternate Email and phone
Your answer
Preferred Days/Times (you can specify days of the week, or times, or even specific dates if you have them).
We anticipate programs to happen at the agreed dates/time, starting in early October, and ending on or before Thanksgiving.
*
Your answer
Have you hosted STEM Ambassadors in the past?
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Yes
No
Would you welcome a STEM Ambassador:
*
In person only
Virtually only ( Every participant must join from their own device to participate. Headphones are strongly encouraged.)
Prefer in person but would welcome virtually if that's the only way we could have one!
Other:
How many youth will be participating?
*
Your answer
Grade level(s) of youth participants (check all that apply)
3rd
4th
5th
6th
7th
8th
Details about your site we should know.
*
Your answer
Would you like information on having the participating youth become enrolled 4-H members?
*
Yes
No
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