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Fall 2022 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
Have you hosted STEM Ambassadors in the past?
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Yes
No
Details about your site we should know.
*
Your answer
Please check all topics and modes of delivery you would consider
Art of Math In Person
Art of Math Virtual
Sustainable Fishing In Person
Sustainable Fishing Virtual
Comments on Module selection - Do you have a strong preference? Are there things we should know?
Your answer
If the STEM Ambassadors are facilitating virtually, I understand that everyone must join from their own device to participate. Participants may join from home, or your site location.
*
Yes
Required
How many youth will be participating?
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Your answer
What grade(s) are youth in?
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Your answer
What technology would you prefer for virtual facilitation?
Zoom only
Google Meet only
Zoom or Google Meet would work
Other:
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, during the timeframe of October 24-November 18, 2022.
*
Your answer
Would you like information on having the participating youth become enrolled 4-H members?
*
Yes
No
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