Wahsega 4-H Center: Environmental Education: Trip Planning Guide

Attendance Registration Form

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Please complete the following fields accurately.

Group Name:

County:

Field Study Dates:

# of Students:

# of Adults:

GROUP TOTAL:

Grade Level (if multiple grades, # of students per grade):

School Type (check one):

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ES-237 Data Collection
We are required by the USDA to present the form below to you. However, you may choose not to respond. The classifications are defined by the USDA and cannot be changed. The data collected is confidential and will not be identified with your school when used for reporting purposes.

The sum of the numbers below does not have to equal the Group Total above.
One person may be represented in multiple classifications.
Please include both adults and students in the classifications below.

Racial Classification:

Male

Female

Race White:			Race White:
Race African American or Black:			Race African American or Black:
Race American Indian or Alaska Native:			Race American Indian or Alaska Native:
Race Asian:			Race Asian:
Race Native Hawaiian or Other Pacific Islander:			Race Native Hawaiian or Other Pacific Islander:

Ethnicity: -- In addition to one or more races, you may classify a person as "Hispanic or Latino".

Male

Female

Ethnicity Hispanic or Latino:

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