Thank you for being willing to take part in this important study about 4-H!  We are inviting you to participate in a study to help us understand the impact that 4-H has on kids. Before you start, though, we want to be sure we share a few important things with you.

This information will help us make sure future programs are really good, and also help us tell the story of how 4-H impacts kids like you in a positive way. This will take you about 30-40 minutes to complete. We know it is pretty long, but we have a lot of information that we need to ask! So thanks for taking the time to fill it out.

You don’t have to do this if you don’t want to, and you can leave any questions you don’t want to answer blank, and you can stop any time you want. There are no right or wrong answers, we just want you to answer each question as honestly as you can. Thanks for your help!!

If your parent did not share the study with you, you should wait until you can talk to them about it before you continue.


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* 1. Which are you?

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* 2. Which are you?

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* 3. How old are you?

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* 4. What county are you from?

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* 5. In what ZIP code is your home located? (enter 5-digit ZIP code; for example, 00544 or 94305)

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* 6. Which of the following best describes you? (Check the one most like you)

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