![](media/image1.png){width="1.0in" height="0.6847222222222222in"}**FALL
2006**

**National 4-H Curriculum**

**Jury Review Process**

*National 4-H Headquarters*

*Cooperative State Research, Education, and Extension Service*

*United States Department of Agriculture*

**Application Form**

+---------------------+------------------------+-----------------------+
| State:              | Institution:           |                       |
+---------------------+------------------------+-----------------------+
| **principal         |                        |                       |
| investigator        |                        |                       |
| Contact             |                        |                       |
| Information**       |                        |                       |
+---------------------+------------------------+-----------------------+
| Name:               |                        |                       |
+---------------------+------------------------+-----------------------+
| Title:              |                        |                       |
+---------------------+------------------------+-----------------------+
| Unive               |                        |                       |
| rsity/Organization: |                        |                       |
|                     |                        |                       |
+---------------------+------------------------+-----------------------+
| Address:            |                        |                       |
+---------------------+------------------------+-----------------------+
| Phone:              | Fax:                   | Email:                |
+---------------------+------------------------+-----------------------+
| **curriculum name** |                        |                       |
+---------------------+------------------------+-----------------------+
| Curriculum Name:    |                        |                       |
| **     **           |                        |                       |
+---------------------+------------------------+-----------------------+
| **SUBMISSION        |                        |                       |
| HISTORY**           |                        |                       |
+---------------------+------------------------+-----------------------+
| This curriculum has |                        |                       |
| never been          |                        |                       |
| submitted for       |                        |                       |
| National Jury       |                        |                       |
| Review.             |                        |                       |
|                     |                        |                       |
| This curriculum was |                        |                       |
| nationally reviewed |                        |                       |
| in April 206 and is |                        |                       |
| being resubmitted.  |                        |                       |
| All required        |                        |                       |
| changes specified   |                        |                       |
| by the jury review  |                        |                       |
| teams have been     |                        |                       |
|                     |                        |                       |
| made.               |                        |                       |
|                     |                        |                       |
| This curriculum was |                        |                       |
| Nationally Jury     |                        |                       |
| Reviewed and was    |                        |                       |
| accepted in         |                        |                       |
| [     ]{.underline} |                        |                       |
| (year).             |                        |                       |
|                     |                        |                       |
| It has not been     |                        |                       |
| updated but is      |                        |                       |
| being resubmitted   |                        |                       |
| for review.         |                        |                       |
|                     |                        |                       |
| It has been updated |                        |                       |
| since the original  |                        |                       |
| acceptance.         |                        |                       |
|                     |                        |                       |
| This curriculum was |                        |                       |
| Nationally Juried   |                        |                       |
| prior to April 2006 |                        |                       |
| and was not         |                        |                       |
| accepted.           |                        |                       |
| Appropriate changes |                        |                       |
| have been made.     |                        |                       |
+---------------------+------------------------+-----------------------+
| **abstract**        |                        |                       |
+---------------------+------------------------+-----------------------+
| Write for a         |                        |                       |
| non-Extension       |                        |                       |
| audience so that an |                        |                       |
| unedited version    |                        |                       |
| could be placed on  |                        |                       |
| a website. Limit    |                        |                       |
| text to 250-300     |                        |                       |
| words.              |                        |                       |
|                     |                        |                       |
|                     |                        |                       |
+---------------------+------------------------+-----------------------+

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+---+----------------------------------+--------------------------------+
|   | Consumer and Family Science:     | Child Development, Child Care, |
|   |                                  | Babysitting, Clothing and      |
|   |                                  | Textiles, Consumer Education,  |
|   |                                  | Home Environment, Parenting    |
|   |                                  | and Family Life Education      |
+---+----------------------------------+--------------------------------+
|   | Biological Sciences:             | Animal Science, Aquatic        |
|   |                                  | Science, Entomology and Bees,  |
|   |                                  | Food Science, Marine Science,  |
|   |                                  | Meat Science, Plant Science,   |
|   |                                  | Poultry Science and Embryology |
+---+----------------------------------+--------------------------------+
|   | Technology and Engineering:      | Aerospace, Automotive,         |
|   |                                  | Bicycle, Computer Technology,  |
|   |                                  | Electric, Electronics,         |
|   |                                  | Engines, GIS, GPS, Robotics,   |
|   |                                  | Tractors and Field Equipment,  |
|   |                                  | Wood Science and Industrial    |
|   |                                  | Arts                           |
+---+----------------------------------+--------------------------------+
|   | Physical Science:                | Astronomy, Chemistry,          |
|   |                                  | Mathematics, Physics,          |
+---+----------------------------------+--------------------------------+
|   | Environmental Education/Earth    | Environmental Stewardship      |
|   | Sciences:                        | (general), Earth, Water, and   |
|   |                                  | Air, Geology and Minerals,     |
|   |                                  | Weather and Climate, Soils and |
|   |                                  | Soil Conservation, Water,      |
|   |                                  | Energy (general, home, farm,   |
|   |                                  | transportation), Forests,      |
|   |                                  | Rangeland, and Wildlife,       |
|   |                                  | Forestry, Range Series,        |
|   |                                  | Wildlife and Fisheries,        |
|   |                                  | Adventure/Challenge, Shooting  |
|   |                                  | Sports, Waste Management,      |
|   |                                  | Composting, Recycling, and     |
|   |                                  | Household Hazardous Waste      |
+---+----------------------------------+--------------------------------+
|   | Ag in the Classroom:             | Ag in the Classroom            |
+---+----------------------------------+--------------------------------+
|   | Animals:                         | Aquaculture, Beef, Birds and   |
|   |                                  | Poultry (caged birds,          |
|   |                                  | chickens, pigeons, waterfowl), |
|   |                                  | Cats, Dogs, Dairy Cattle,      |
|   |                                  | Goats (Dairy, Hair, Meat,      |
|   |                                  | Pygmy), Horse and Pony,        |
|   |                                  | Rabbits/Cavies, Sheep, Small   |
|   |                                  | Animals/Pocket Pets/Lab        |
|   |                                  | Animals, Swine, Alpacas and    |
|   |                                  | Llamas                         |
|   |                                  |                                |
|   |                                  | Emus and Ostriches             |
+---+----------------------------------+--------------------------------+
|   | Plant Science:                   | Crops/Weeds                    |
+---+----------------------------------+--------------------------------+
|   |                                  |                                |
| * |                                  |                                |
| * |                                  |                                |
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| D |                                  |                                |
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| ) |                                  |                                |
| * |                                  |                                |
| * |                                  |                                |
+---+----------------------------------+--------------------------------+
|   | Civic Engagement:                | Citizenship (local, state, and |
|   |                                  | national), Cultural Education  |
|   |                                  | (including heritage,           |
|   |                                  | diversity, exchanges), Global  |
|   |                                  | Education (including           |
|   |                                  | international exchanges, if    |
|   |                                  | enrolled), Intergenerational   |
|   |                                  | Programming, and Understanding |
|   |                                  | Physical and Mental            |
|   |                                  | Limitations                    |
+---+----------------------------------+--------------------------------+
|   | Community/Volunteer:             | Volunteerism, Service          |
|   |                                  | Learning, and Community        |
|   |                                  | Service                        |
+---+----------------------------------+--------------------------------+
|   | Leadership and Personal          | Career Exploration and         |
|   | Development:                     | Employability, Critical        |
|   |                                  | Thinking Skills Economics,     |
|   |                                  | Business and Marketing,        |
|   |                                  | Mini-Society (specific         |
|   |                                  | entrepreneurial program),      |
|   |                                  | Other Entrepreneurships,       |
|   |                                  | Introductory                   |
|   |                                  |                                |
|   |                                  | 4-H Projects (including        |
|   |                                  | participants 5-8 year old),    |
|   |                                  | Hobbies and Collections,       |
|   |                                  | Leadership Skills Development, |
|   |                                  | Leisure Education (general),   |
|   |                                  | Personal Development           |
|   |                                  | (general), Reading Literacy,   |
|   |                                  | Social Recreation Skills,      |
|   |                                  | Values Clarification, and      |
|   |                                  | Character Education            |
+---+----------------------------------+--------------------------------+
|   | Communications and Expressive    | Communication Arts             |
|   | Arts:                            | (Spe                           |
|   |                                  | aking/Radio/TV/Writing/Print), |
|   |                                  | Performing Arts                |
|   |                                  | (Clowning/Mime,                |
|   |                                  | Dance/Movement, Drama/Theater, |
|   |                                  | Music/Sound), and Visual Arts  |
|   |                                  | (Arts and Crafts,              |
|   |                                  | Drawing/Painting/Sculpture,    |
|   |                                  | Graphic Art/Displays/Exhibits, |
|   |                                  | and Photography/Video)         |
+---+----------------------------------+--------------------------------+
|   |                                  |                                |
| * |                                  |                                |
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| A |                                  |                                |
| L |                                  |                                |
| T |                                  |                                |
| H |                                  |                                |
| Y |                                  |                                |
| L |                                  |                                |
| I |                                  |                                |
| F |                                  |                                |
| E |                                  |                                |
| S |                                  |                                |
| T |                                  |                                |
| Y |                                  |                                |
| L |                                  |                                |
| E |                                  |                                |
| S |                                  |                                |
| ( |                                  |                                |
| M |                                  |                                |
| I |                                  |                                |
| S |                                  |                                |
| S |                                  |                                |
| I |                                  |                                |
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| M |                                  |                                |
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| D |                                  |                                |
| A |                                  |                                |
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| ) |                                  |                                |
| * |                                  |                                |
| * |                                  |                                |
+---+----------------------------------+--------------------------------+
|   | Foods and Nutrition:             | EFNEP (All youth participants  |
|   |                                  | of EFNEP programs), Foods      |
|   |                                  | Safety, Food Preservation, and |
|   |                                  | FSNEP (Food Stamp Nutrition    |
|   |                                  | Education Program), Food       |
|   |                                  | Preparation, Nutrition         |
+---+----------------------------------+--------------------------------+
|   | Health:                          | Chemical Health, Mental and    |
|   |                                  | Emotional Health, and Physical |
|   |                                  | Health (Fitness and Sports,    |
|   |                                  | Growth, Development, and       |
|   |                                  | Disease, Home Nursing, First   |
|   |                                  | Aid/CPR, and Sexual Health)    |
+---+----------------------------------+--------------------------------+
|   | Personal Safety:                 | ATV Safety, Automotive Safety  |
|   |                                  | (including seat belts, etc.),  |
|   |                                  | Bicycle Safety, Communities    |
|   |                                  | for Child Safety, Emergency    |
|   |                                  | Preparedness, Tractor and      |
|   |                                  | Machinery Safety               |
|   |                                  | Certification, Other Personal  |
|   |                                  | Safety                         |
+---+----------------------------------+--------------------------------+

+--------+-------------------------+-----------------------------------+
| **curr |                         |                                   |
| iculum |                         |                                   |
| compon |                         |                                   |
| ents** |                         |                                   |
|        |                         |                                   |
| Check  |                         |                                   |
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| that   |                         |                                   |
| apply. |                         |                                   |
+--------+-------------------------+-----------------------------------+
| Mat    | Printed Materials       |                                   |
| erials | (activity sheets,       |                                   |
| for    | booklets, etc.) List    |                                   |
| youth  | documents with number   |                                   |
|        | of pages:               |                                   |
|        |                         |                                   |
|        |   -                     |                                   |
|        | ---- ---------- ------- |                                   |
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|        | Web Based Materials     |                                   |
|        | **Specify web           |                                   |
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|        | Interactive Resources   |                                   |
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|        | - --------------------- |                                   |
|        |                         |                                   |
|        | Other curriculum        |                                   |
|        | components not listed   |                                   |
|        | above (specify):        |                                   |
+--------+-------------------------+-----------------------------------+
| Guides | Printed Materials       |                                   |
| and    | (activity sheets,       |                                   |
| mat    | booklets, etc.) List    |                                   |
| erials | documents with number   |                                   |
| for    | of pages:               |                                   |
| youth  |                         |                                   |
| and    |   -                     |                                   |
| adult  | ---- ---------- ------- |                                   |
| l      | - --------------------- |                                   |
| eaders |                         |                                   |
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|        |                         |                                   |
|        | CD Rom                  |                                   |
|        |                         |                                   |
|        | Interactive Resources   |                                   |
|        | \# of                   |                                   |
|        | resour                  |                                   |
|        | ces:[     ]{.underline} |                                   |
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|        | Print (PDF) Resources   |                                   |
|        | -- List items with      |                                   |
|        | number of pages:        |                                   |
|        |                         |                                   |
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|        |               pages:    |                                   |
|        |   -                     |                                   |
|        | ---- ---------- ------- |                                   |
|        | - --------------------- |                                   |
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|        | Web Based Materials     |                                   |
|        | **Specify web           |                                   |
|        | address:**              |                                   |
|        | [     ]{.underline}     |                                   |
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|        | Interactive Resources   |                                   |
|        | \# of                   |                                   |
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|        | number of pages:        |                                   |
|        |                         |                                   |
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|        | ---- ---------- ------- |                                   |
|        | - --------------------- |                                   |
|        |                         |                                   |
|        | Other curriculum        |                                   |
|        | components not listed   |                                   |
|        | above (specify):        |                                   |
+--------+-------------------------+-----------------------------------+
| Guides | Printed Materials       |                                   |
| and    | (activity sheets,       |                                   |
| mat    | booklets, etc.) List    |                                   |
| erials | documents with number   |                                   |
| for    | of pages:               |                                   |
| p      |                         |                                   |
| arents |   -                     |                                   |
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|        |                         |                                   |
|        | Print (PDF) Resources   |                                   |
|        | -- List items with      |                                   |
|        | number of pages:        |                                   |
|        |                         |                                   |
|        |   -                     |                                   |
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|        |               pages:    |                                   |
|        |   -                     |                                   |
|        | ---- ---------- ------- |                                   |
|        | - --------------------- |                                   |
|        |                         |                                   |
|        | Web Based Materials     |                                   |
|        | **Specify web           |                                   |
|        | address:**              |                                   |
|        | [     ]{.underline}     |                                   |
|        |                         |                                   |
|        | Interactive Resources   |                                   |
|        | \# of                   |                                   |
|        | resour                  |                                   |
|        | ces:[     ]{.underline} |                                   |
|        |                         |                                   |
|        | Print (PDF) Resources   |                                   |
|        | -- List items with      |                                   |
|        | number of pages:        |                                   |
|        |                         |                                   |
|        |   -                     |                                   |
|        | ---- ---------- ------- |                                   |
|        | - --------------------- |                                   |
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|        |  1\.              \# of |                                   |
|        |     [     ]{.underline} |                                   |
|        |                         |                                   |
|        |               pages:    |                                   |
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|        |  2\.              \# of |                                   |
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|        |               pages:    |                                   |
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|        |     [     ]{.underline} |                                   |
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|        |               pages:    |                                   |
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|        |     [     ]{.underline} |                                   |
|        |                         |                                   |
|        |               pages:    |                                   |
|        |   -                     |                                   |
|        | ---- ---------- ------- |                                   |
|        | - --------------------- |                                   |
|        |                         |                                   |
|        | Other curriculum        |                                   |
|        | components not listed   |                                   |
|        | above (specify):        |                                   |
+--------+-------------------------+-----------------------------------+
| Yes No |                         |                                   |
| Are    |                         |                                   |
| eval   |                         |                                   |
| uation |                         |                                   |
| tools  |                         |                                   |
| in     |                         |                                   |
| cluded |                         |                                   |
| that   |                         |                                   |
| pr     |                         |                                   |
| ograms |                         |                                   |
| can    |                         |                                   |
| use to |                         |                                   |
| ev     |                         |                                   |
| aluate |                         |                                   |
| the    |                         |                                   |
| impact |                         |                                   |
| of     |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| with   |                         |                                   |
| youth? |                         |                                   |
+--------+-------------------------+-----------------------------------+
|        |                         |                                   |
| S      |                         |                                   |
| pecify |                         |                                   |
| any    |                         |                                   |
| other  |                         |                                   |
| types  |                         |                                   |
| of     |                         |                                   |
| mat    |                         |                                   |
| erials |                         |                                   |
| that   |                         |                                   |
| are    |                         |                                   |
| in     |                         |                                   |
| cluded |                         |                                   |
| or     |                         |                                   |
| re     |                         |                                   |
| quired |                         |                                   |
| to     |                         |                                   |
| imp    |                         |                                   |
| lement |                         |                                   |
| the    |                         |                                   |
| curri  |                         |                                   |
| culum. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **S    |                         |                                   |
| pecial |                         |                                   |
| target |                         |                                   |
| audi   |                         |                                   |
| ence** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| Age or |                         | Language(s):                      |
| Grade  |                         |                                   |
| Ran    |                         |                                   |
| ge(s): |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| Race,  |                         | Male and/or female:               |
| ethn   |                         |                                   |
| icity, |                         |                                   |
| cu     |                         |                                   |
| lture: |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| S      |                         |                                   |
| pecial |                         |                                   |
| Needs  |                         |                                   |
| (      |                         |                                   |
| please |                         |                                   |
| spe    |                         |                                   |
| cify): |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **r    |                         |                                   |
| eading |                         |                                   |
| le     |                         |                                   |
| vels** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| At     |                         |                                   |
| what   |                         |                                   |
| r      |                         |                                   |
| eading |                         |                                   |
| level  |                         |                                   |
| for    |                         |                                   |
| youth  |                         |                                   |
| is the |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| des    |                         |                                   |
| igned? |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| E      |                         |                                   |
| xplain |                         |                                   |
| how    |                         |                                   |
| the    |                         |                                   |
| r      |                         |                                   |
| eading |                         |                                   |
| level  |                         |                                   |
| for    |                         |                                   |
| youth  |                         |                                   |
| was    |                         |                                   |
| deter  |                         |                                   |
| mined. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| At     |                         |                                   |
| what   |                         |                                   |
| r      |                         |                                   |
| eading |                         |                                   |
| level  |                         |                                   |
| for    |                         |                                   |
| adults |                         |                                   |
| is the |                         |                                   |
| leader |                         |                                   |
| guide  |                         |                                   |
| ma     |                         |                                   |
| terial |                         |                                   |
| deve   |                         |                                   |
| loped? |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| E      |                         |                                   |
| xplain |                         |                                   |
| how    |                         |                                   |
| the    |                         |                                   |
| r      |                         |                                   |
| eading |                         |                                   |
| level  |                         |                                   |
| for    |                         |                                   |
| adults |                         |                                   |
| was    |                         |                                   |
| dete   |                         |                                   |
| rmined |                         |                                   |
| for    |                         |                                   |
| the    |                         |                                   |
| leader |                         |                                   |
| guide  |                         |                                   |
| mate   |                         |                                   |
| rials. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| *      |                         |                                   |
| *scope |                         |                                   |
| of     |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| and    |                         |                                   |
| Le     |                         |                                   |
| arning |                         |                                   |
| ac     |                         |                                   |
| tiviti |                         |                                   |
| es/les |                         |                                   |
| sons** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| What   |                         |                                   |
| is the |                         |                                   |
| a      |                         |                                   |
| verage |                         |                                   |
| length |                         |                                   |
| of     |                         |                                   |
| time   |                         |                                   |
| needed |                         |                                   |
| for    |                         |                                   |
| each   |                         |                                   |
| le     |                         |                                   |
| arning |                         |                                   |
| acti   |                         |                                   |
| vity/l |                         |                                   |
| esson? |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| What   |                         |                                   |
| is the |                         |                                   |
| appro  |                         |                                   |
| ximate |                         |                                   |
| number |                         |                                   |
| of     |                         |                                   |
| indi   |                         |                                   |
| vidual |                         |                                   |
| le     |                         |                                   |
| arning |                         |                                   |
| activi |                         |                                   |
| ties/l |                         |                                   |
| essons |                         |                                   |
| for    |                         |                                   |
| the    |                         |                                   |
| entire |                         |                                   |
| curri  |                         |                                   |
| culum? |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| What   |                         |                                   |
| is the |                         |                                   |
| appro  |                         |                                   |
| priate |                         |                                   |
| cost   |                         |                                   |
| of     |                         |                                   |
| implem |                         |                                   |
| enting |                         |                                   |
| the    |                         |                                   |
| entire |                         |                                   |
| curri  |                         |                                   |
| culum? |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| What   |                         |                                   |
| is the |                         |                                   |
| a      |                         |                                   |
| verage |                         |                                   |
| amount |                         |                                   |
| of     |                         |                                   |
| time   |                         |                                   |
| re     |                         |                                   |
| quired |                         |                                   |
| for    |                         |                                   |
| the    |                         |                                   |
| staff  |                         |                                   |
| to     |                         |                                   |
| p      |                         |                                   |
| repare |                         |                                   |
| for    |                         |                                   |
| each   |                         |                                   |
| le     |                         |                                   |
| arning |                         |                                   |
| acti   |                         |                                   |
| vity/l |                         |                                   |
| esson? |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **re   |                         |                                   |
| levant |                         |                                   |
| de     |                         |                                   |
| livery |                         |                                   |
| m      |                         |                                   |
| odes** |                         |                                   |
|        |                         |                                   |
| (check |                         |                                   |
| all    |                         |                                   |
| that   |                         |                                   |
| apply) |                         |                                   |
+--------+-------------------------+-----------------------------------+
| 4-H    |                         |                                   |
| Clubs  |                         |                                   |
| Ove    |                         |                                   |
| rnight |                         |                                   |
| C      |                         |                                   |
| amping |                         |                                   |
| Pr     |                         |                                   |
| ograms |                         |                                   |
| Indi   |                         |                                   |
| vidual |                         |                                   |
| Study  |                         |                                   |
| Intera |                         |                                   |
| ctions |                         |                                   |
| with   |                         |                                   |
| Family |                         |                                   |
|        |                         |                                   |
| School |                         |                                   |
| Enri   |                         |                                   |
| chment |                         |                                   |
| Day    |                         |                                   |
| Camp   |                         |                                   |
| s/Shor |                         |                                   |
| t-Term |                         |                                   |
| S      |                         |                                   |
| pecial |                         |                                   |
| In     |                         |                                   |
| terest |                         |                                   |
| Vol    |                         |                                   |
| unteer |                         |                                   |
| /Staff |                         |                                   |
| Devel  |                         |                                   |
| opment |                         |                                   |
| After- |                         |                                   |
| school |                         |                                   |
|        |                         |                                   |
| Other  |                         |                                   |
| (Spe   |                         |                                   |
| cify): |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **Pr   |                         |                                   |
| oposal |                         |                                   |
| Narra  |                         |                                   |
| tive** |                         |                                   |
|        |                         |                                   |
| Please |                         |                                   |
| do not |                         |                                   |
| exceed |                         |                                   |
| a      |                         |                                   |
| m      |                         |                                   |
| aximum |                         |                                   |
| of 6   |                         |                                   |
| pages. |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **sta  |                         |                                   |
| tement |                         |                                   |
| of     |                         |                                   |
| need   |                         |                                   |
| and    |                         |                                   |
| rat    |                         |                                   |
| ionale |                         |                                   |
| for    |                         |                                   |
| pri    |                         |                                   |
| ority; |                         |                                   |
| scope  |                         |                                   |
| and    |                         |                                   |
| app    |                         |                                   |
| ropria |                         |                                   |
| teness |                         |                                   |
| for    |                         |                                   |
| after- |                         |                                   |
| school |                         |                                   |
| prog   |                         |                                   |
| rams** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| why    |                         |                                   |
| this   |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| is a   |                         |                                   |
| pr     |                         |                                   |
| iority |                         |                                   |
| within |                         |                                   |
| 4-H    |                         |                                   |
| and    |                         |                                   |
| for    |                         |                                   |
| youth  |                         |                                   |
| in     |                         |                                   |
| ge     |                         |                                   |
| neral. |                         |                                   |
| De     |                         |                                   |
| scribe |                         |                                   |
| w      |                         |                                   |
| hether |                         |                                   |
| or not |                         |                                   |
| it is  |                         |                                   |
| appro  |                         |                                   |
| priate |                         |                                   |
| for    |                         |                                   |
| use in |                         |                                   |
| after- |                         |                                   |
| school |                         |                                   |
| pro    |                         |                                   |
| grams. |                         |                                   |
|        |                         |                                   |
| **     |                         |                                   |
|     ** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **ou   |                         |                                   |
| tcomes |                         |                                   |
| and    |                         |                                   |
| indica |                         |                                   |
| tors** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| the    |                         |                                   |
| in     |                         |                                   |
| tended |                         |                                   |
| ou     |                         |                                   |
| tcomes |                         |                                   |
| that   |                         |                                   |
| will   |                         |                                   |
| be     |                         |                                   |
| ac     |                         |                                   |
| hieved |                         |                                   |
| as a   |                         |                                   |
| result |                         |                                   |
| of the |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| and    |                         |                                   |
| the    |                         |                                   |
| indi   |                         |                                   |
| cators |                         |                                   |
| that   |                         |                                   |
| are    |                         |                                   |
| used   |                         |                                   |
| to     |                         |                                   |
| m      |                         |                                   |
| easure |                         |                                   |
| the    |                         |                                   |
| out    |                         |                                   |
| comes. |                         |                                   |
|        |                         |                                   |
| **     |                         |                                   |
|     ** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **     |                         |                                   |
| Experi |                         |                                   |
| ential |                         |                                   |
| Le     |                         |                                   |
| arning |                         |                                   |
| M      |                         |                                   |
| ethodo |                         |                                   |
| logy** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| how    |                         |                                   |
| the    |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| ut     |                         |                                   |
| ilizes |                         |                                   |
| experi |                         |                                   |
| ential |                         |                                   |
| educ   |                         |                                   |
| ation. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| how    |                         |                                   |
| the    |                         |                                   |
| mat    |                         |                                   |
| erials |                         |                                   |
| are    |                         |                                   |
| de     |                         |                                   |
| signed |                         |                                   |
| to fit |                         |                                   |
| the    |                         |                                   |
| in     |                         |                                   |
| tended |                         |                                   |
| de     |                         |                                   |
| livery |                         |                                   |
| mo     |                         |                                   |
| de(s). |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **TEEN |                         |                                   |
| AND    |                         |                                   |
| VOL    |                         |                                   |
| UNTEER |                         |                                   |
| LEADER |                         |                                   |
| MATER  |                         |                                   |
| IALS** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| how    |                         |                                   |
| adults |                         |                                   |
| and    |                         |                                   |
| youth  |                         |                                   |
| are    |                         |                                   |
| in     |                         |                                   |
| volved |                         |                                   |
| in the |                         |                                   |
| im     |                         |                                   |
| plemen |                         |                                   |
| tation |                         |                                   |
| and    |                         |                                   |
| eval   |                         |                                   |
| uation |                         |                                   |
| of the |                         |                                   |
| le     |                         |                                   |
| arning |                         |                                   |
| p      |                         |                                   |
| rocess |                         |                                   |
| of the |                         |                                   |
| curri  |                         |                                   |
| culum. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| the    |                         |                                   |
| tr     |                         |                                   |
| aining |                         |                                   |
| mat    |                         |                                   |
| erials |                         |                                   |
| that   |                         |                                   |
| assist |                         |                                   |
| adults |                         |                                   |
| and/or |                         |                                   |
| older  |                         |                                   |
| youth  |                         |                                   |
| in     |                         |                                   |
| implem |                         |                                   |
| enting |                         |                                   |
| the    |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| and in |                         |                                   |
| using  |                         |                                   |
| the    |                         |                                   |
| experi |                         |                                   |
| ential |                         |                                   |
| le     |                         |                                   |
| arning |                         |                                   |
| pr     |                         |                                   |
| ocess. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **L    |                         |                                   |
| earner |                         |                                   |
| Cent   |                         |                                   |
| ered** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| the    |                         |                                   |
| v      |                         |                                   |
| ariety |                         |                                   |
| of     |                         |                                   |
| educa  |                         |                                   |
| tional |                         |                                   |
| exper  |                         |                                   |
| iences |                         |                                   |
| in     |                         |                                   |
| cluded |                         |                                   |
| in the |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| that   |                         |                                   |
| engage |                         |                                   |
| a      |                         |                                   |
| v      |                         |                                   |
| ariety |                         |                                   |
| of     |                         |                                   |
| le     |                         |                                   |
| arning |                         |                                   |
| s      |                         |                                   |
| tyles. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| how    |                         |                                   |
| the    |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| is     |                         |                                   |
| dev    |                         |                                   |
| elopme |                         |                                   |
| ntally |                         |                                   |
| appro  |                         |                                   |
| priate |                         |                                   |
| in     |                         |                                   |
| co     |                         |                                   |
| ntent, |                         |                                   |
| r      |                         |                                   |
| eading |                         |                                   |
| l      |                         |                                   |
| evels, |                         |                                   |
| activ  |                         |                                   |
| ities, |                         |                                   |
| and    |                         |                                   |
| recogn |                         |                                   |
| ition. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| m      |                         |                                   |
| ethods |                         |                                   |
| used   |                         |                                   |
| in the |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| that   |                         |                                   |
| enc    |                         |                                   |
| ourage |                         |                                   |
| exci   |                         |                                   |
| tement |                         |                                   |
| about  |                         |                                   |
| lea    |                         |                                   |
| rning. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| how    |                         |                                   |
| the    |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| cros   |                         |                                   |
| s-refe |                         |                                   |
| rences |                         |                                   |
| na     |                         |                                   |
| tional |                         |                                   |
| sta    |                         |                                   |
| ndards |                         |                                   |
| in     |                         |                                   |
| areas  |                         |                                   |
| such   |                         |                                   |
| as     |                         |                                   |
| sc     |                         |                                   |
| ience, |                         |                                   |
| wor    |                         |                                   |
| kforce |                         |                                   |
| c      |                         |                                   |
| ompete |                         |                                   |
| ncies, |                         |                                   |
| and    |                         |                                   |
| educ   |                         |                                   |
| ation. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| how    |                         |                                   |
| the    |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| is     |                         |                                   |
| sen    |                         |                                   |
| sitive |                         |                                   |
| to     |                         |                                   |
| cul    |                         |                                   |
| tures, |                         |                                   |
| races, |                         |                                   |
| and    |                         |                                   |
| ethnic |                         |                                   |
| ities. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **S    |                         |                                   |
| ubject |                         |                                   |
| Matter |                         |                                   |
| con    |                         |                                   |
| tent** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| the    |                         |                                   |
| re     |                         |                                   |
| search |                         |                                   |
| base   |                         |                                   |
| that   |                         |                                   |
| is     |                         |                                   |
| used   |                         |                                   |
| in the |                         |                                   |
| curri  |                         |                                   |
| culum. |                         |                                   |
| I      |                         |                                   |
| nclude |                         |                                   |
| s      |                         |                                   |
| ources |                         |                                   |
| of     |                         |                                   |
| infor  |                         |                                   |
| mation |                         |                                   |
| that   |                         |                                   |
| was    |                         |                                   |
| used   |                         |                                   |
| for    |                         |                                   |
| the    |                         |                                   |
| su     |                         |                                   |
| bject- |                         |                                   |
| matter |                         |                                   |
| co     |                         |                                   |
| ntent. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| human  |                         |                                   |
| devel  |                         |                                   |
| opment |                         |                                   |
| and    |                         |                                   |
| youth  |                         |                                   |
| devel  |                         |                                   |
| opment |                         |                                   |
| re     |                         |                                   |
| search |                         |                                   |
| that   |                         |                                   |
| was    |                         |                                   |
| used   |                         |                                   |
| in the |                         |                                   |
| curri  |                         |                                   |
| culum. |                         |                                   |
| I      |                         |                                   |
| nclude |                         |                                   |
| s      |                         |                                   |
| ources |                         |                                   |
| of     |                         |                                   |
| inform |                         |                                   |
| ation. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **d    |                         |                                   |
| esign, |                         |                                   |
| f      |                         |                                   |
| ormat, |                         |                                   |
| and    |                         |                                   |
| packa  |                         |                                   |
| ging** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| the    |                         |                                   |
| d      |                         |                                   |
| esign, |                         |                                   |
| f      |                         |                                   |
| ormat, |                         |                                   |
| and    |                         |                                   |
| pac    |                         |                                   |
| kaging |                         |                                   |
| of the |                         |                                   |
| mat    |                         |                                   |
| erials |                         |                                   |
| that   |                         |                                   |
| are    |                         |                                   |
| used   |                         |                                   |
| in the |                         |                                   |
| curr   |                         |                                   |
| iculum |                         |                                   |
| and    |                         |                                   |
| in     |                         |                                   |
| dicate |                         |                                   |
| app    |                         |                                   |
| ropria |                         |                                   |
| teness |                         |                                   |
| for    |                         |                                   |
| the    |                         |                                   |
| ex     |                         |                                   |
| pected |                         |                                   |
| re     |                         |                                   |
| sults. |                         |                                   |
| Are    |                         |                                   |
| the    |                         |                                   |
| mat    |                         |                                   |
| erials |                         |                                   |
| user   |                         |                                   |
| fri    |                         |                                   |
| endly? |                         |                                   |
|        |                         |                                   |
| **     |                         |                                   |
|     ** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **Eval |                         |                                   |
| uation |                         |                                   |
| and    |                         |                                   |
| pilot  |                         |                                   |
| tes    |                         |                                   |
| ting** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| the    |                         |                                   |
| eval   |                         |                                   |
| uation |                         |                                   |
| design |                         |                                   |
| and    |                         |                                   |
| m      |                         |                                   |
| ethodo |                         |                                   |
| logies |                         |                                   |
| that   |                         |                                   |
| are    |                         |                                   |
| in     |                         |                                   |
| cluded |                         |                                   |
| for    |                         |                                   |
| use in |                         |                                   |
| deter  |                         |                                   |
| mining |                         |                                   |
| actual |                         |                                   |
| ou     |                         |                                   |
| tcomes |                         |                                   |
| of the |                         |                                   |
| curric |                         |                                   |
| ulum.  |                         |                                   |
| I      |                         |                                   |
| nclude |                         |                                   |
| sug    |                         |                                   |
| gested |                         |                                   |
| tools  |                         |                                   |
| or     |                         |                                   |
| strat  |                         |                                   |
| egies. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| De     |                         |                                   |
| scribe |                         |                                   |
| the    |                         |                                   |
| pilot  |                         |                                   |
| t      |                         |                                   |
| esting |                         |                                   |
| metho  |                         |                                   |
| dology |                         |                                   |
| and    |                         |                                   |
| design |                         |                                   |
| that   |                         |                                   |
| was    |                         |                                   |
| used   |                         |                                   |
| in the |                         |                                   |
| devel  |                         |                                   |
| opment |                         |                                   |
| p      |                         |                                   |
| rocess |                         |                                   |
| of the |                         |                                   |
| curri  |                         |                                   |
| culum. |                         |                                   |
| P      |                         |                                   |
| rovide |                         |                                   |
| summ   |                         |                                   |
| arized |                         |                                   |
| and    |                         |                                   |
| an     |                         |                                   |
| alyzed |                         |                                   |
| r      |                         |                                   |
| esults |                         |                                   |
| (e.g.  |                         |                                   |
| number |                         |                                   |
| of     |                         |                                   |
| sub    |                         |                                   |
| jects, |                         |                                   |
| c      |                         |                                   |
| ontrol |                         |                                   |
| g      |                         |                                   |
| roups, |                         |                                   |
| m      |                         |                                   |
| ethods |                         |                                   |
| for    |                         |                                   |
| anal   |                         |                                   |
| yzing, |                         |                                   |
| fin    |                         |                                   |
| dings) |                         |                                   |
| of     |                         |                                   |
| both   |                         |                                   |
| for    |                         |                                   |
| mative |                         |                                   |
| and    |                         |                                   |
| sum    |                         |                                   |
| mative |                         |                                   |
| evalua |                         |                                   |
| tions. |                         |                                   |
| In     |                         |                                   |
| ad     |                         |                                   |
| dition |                         |                                   |
| to     |                         |                                   |
| for    |                         |                                   |
| mative |                         |                                   |
| evalu  |                         |                                   |
| ations |                         |                                   |
| (did   |                         |                                   |
| the    |                         |                                   |
| youth  |                         |                                   |
| like   |                         |                                   |
| the    |                         |                                   |
| curri  |                         |                                   |
| culum) |                         |                                   |
| sum    |                         |                                   |
| mative |                         |                                   |
| evalu  |                         |                                   |
| ations |                         |                                   |
| (kno   |                         |                                   |
| wledge |                         |                                   |
| and    |                         |                                   |
| skill  |                         |                                   |
| gain)  |                         |                                   |
| should |                         |                                   |
| also   |                         |                                   |
| be     |                         |                                   |
| inc    |                         |                                   |
| luded. |                         |                                   |
| De     |                         |                                   |
| scribe |                         |                                   |
| other  |                         |                                   |
| evalu  |                         |                                   |
| ations |                         |                                   |
| that   |                         |                                   |
| have   |                         |                                   |
| been   |                         |                                   |
| implem |                         |                                   |
| ented. |                         |                                   |
|        |                         |                                   |
|        |                         |                                   |
+--------+-------------------------+-----------------------------------+
| **addi |                         |                                   |
| tional |                         |                                   |
| quest  |                         |                                   |
| ions** |                         |                                   |
+--------+-------------------------+-----------------------------------+
| Are    |                         |                                   |
| tech   |                         |                                   |
| nology |                         |                                   |
| based  |                         |                                   |
| mat    |                         |                                   |
| erials |                         |                                   |
| ADA    |                         |                                   |
| comp   |                         |                                   |
| liant? |                         |                                   |
| Yes No |                         |                                   |
|        |                         |                                   |
| If     |                         |                                   |
| not,   |                         |                                   |
| what   |                         |                                   |
| are    |                         |                                   |
| plans  |                         |                                   |
| to     |                         |                                   |
| move   |                         |                                   |
| in     |                         |                                   |
| that   |                         |                                   |
| dire   |                         |                                   |
| ction? |                         |                                   |
|        |                         |                                   |
| Antic  |                         |                                   |
| ipated |                         |                                   |
| date   |                         |                                   |
| mat    |                         |                                   |
| erials |                         |                                   |
| will   |                         |                                   |
| be ADA |                         |                                   |
| com    |                         |                                   |
| pliant |                         |                                   |
| [      |                         |                                   |
|      ] |                         |                                   |
| {.unde |                         |                                   |
| rline} |                         |                                   |
| .      |                         |                                   |
+--------+-------------------------+-----------------------------------+
| Have   |                         |                                   |
| eval   |                         |                                   |
| uation |                         |                                   |
| tools  |                         |                                   |
| and    |                         |                                   |
| pro    |                         |                                   |
| cesses |                         |                                   |
| been   |                         |                                   |
| c      |                         |                                   |
| leared |                         |                                   |
| by the |                         |                                   |
| univ   |                         |                                   |
| ersity |                         |                                   |
| I      |                         |                                   |
| nstitu |                         |                                   |
| tional |                         |                                   |
| Review |                         |                                   |
| Board? |                         |                                   |
| Yes No |                         |                                   |
|        |                         |                                   |
| If so, |                         |                                   |
| what   |                         |                                   |
| was    |                         |                                   |
| the    |                         |                                   |
| ap     |                         |                                   |
| proval |                         |                                   |
| date?  |                         |                                   |
| [      |                         |                                   |
|      ] |                         |                                   |
| {.unde |                         |                                   |
| rline} |                         |                                   |
|        |                         |                                   |
| If     |                         |                                   |
| not,   |                         |                                   |
| e      |                         |                                   |
| xplain |                         |                                   |
| plans  |                         |                                   |
| for    |                         |                                   |
| subm   |                         |                                   |
| ission |                         |                                   |
| and    |                         |                                   |
| cle    |                         |                                   |
| arance |                         |                                   |
| or     |                         |                                   |
| reason |                         |                                   |
| it     |                         |                                   |
| might  |                         |                                   |
| be     |                         |                                   |
| exempt |                         |                                   |
| based  |                         |                                   |
| on the |                         |                                   |
| univ   |                         |                                   |
| ersity |                         |                                   |
| pol    |                         |                                   |
| icies. |                         |                                   |
|        |                         |                                   |
| [      |                         |                                   |
|      ] |                         |                                   |
| {.unde |                         |                                   |
| rline} |                         |                                   |
+--------+-------------------------+-----------------------------------+

+---------------------+-----------------------+-----------------------+
| **primary project   |                       |                       |
| staff**             |                       |                       |
+---------------------+-----------------------+-----------------------+
| **Lead              |                       |                       |
| Author/Design Team  |                       |                       |
| Coordinator**       |                       |                       |
+---------------------+-----------------------+-----------------------+
| Name:               |                       |                       |
+---------------------+-----------------------+-----------------------+
| Title:              |                       |                       |
+---------------------+-----------------------+-----------------------+
| University:         |                       |                       |
+---------------------+-----------------------+-----------------------+
| Address:            |                       |                       |
|                     |                       |                       |
|                     |                       |                       |
+---------------------+-----------------------+-----------------------+
| Phone:              | Fax:                  | Email:                |
+---------------------+-----------------------+-----------------------+
| Summary of academic |                       |                       |
| training,           |                       |                       |
| experience and      |                       |                       |
| awards as they      |                       |                       |
| relate to this      |                       |                       |
| project.            |                       |                       |
|                     |                       |                       |
|                     |                       |                       |
+---------------------+-----------------------+-----------------------+
| **Contributing      |                       |                       |
| Author(s)           |                       |                       |
| (Duplicate this     |                       |                       |
| section as          |                       |                       |
| needed)**           |                       |                       |
+---------------------+-----------------------+-----------------------+
| Name:               |                       |                       |
+---------------------+-----------------------+-----------------------+
| Title:              |                       |                       |
+---------------------+-----------------------+-----------------------+
| University:         |                       |                       |
+---------------------+-----------------------+-----------------------+
| Address:            |                       |                       |
|                     |                       |                       |
|                     |                       |                       |
+---------------------+-----------------------+-----------------------+
| Phone:              | Fax:                  | Email:                |
+---------------------+-----------------------+-----------------------+
| Summary of academic |                       |                       |
| training,           |                       |                       |
| experience and      |                       |                       |
| awards as they      |                       |                       |
| relate to this      |                       |                       |
| project.            |                       |                       |
|                     |                       |                       |
|                     |                       |                       |
+---------------------+-----------------------+-----------------------+

+---------------------+------------+----------+--------------+-------+
| **curriculum        |            |          |              |       |
| development         |            |          |              |       |
| information**       |            |          |              |       |
|                     |            |          |              |       |
| A page break has    |            |          |              |       |
| been inserted so    |            |          |              |       |
| that the Curriculum |            |          |              |       |
| Development and     |            |          |              |       |
| Person Submitting   |            |          |              |       |
| Application         |            |          |              |       |
| information will    |            |          |              |       |
| remain on one page. |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Date curriculum was |            |          |              |       |
| finalized:          |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Copyright is/will   |            |          |              |       |
| be held by:         |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| By submitting       |            |          |              |       |
| proposals for       |            |          |              |       |
| review, the         |            |          |              |       |
| institution agrees  |            |          |              |       |
| to make the         |            |          |              |       |
| curriculum          |            |          |              |       |
| available in some   |            |          |              |       |
| form for five years |            |          |              |       |
| following           |            |          |              |       |
| acceptance into the |            |          |              |       |
| National Collection |            |          |              |       |
| (if it has not been |            |          |              |       |
| funded by a         |            |          |              |       |
| national            |            |          |              |       |
| organization and/or |            |          |              |       |
| if the national     |            |          |              |       |
| organization does   |            |          |              |       |
| not continue to     |            |          |              |       |
| produce the         |            |          |              |       |
| selected            |            |          |              |       |
| curriculum). If a   |            |          |              |       |
| commitment cannot   |            |          |              |       |
| be made to keep the |            |          |              |       |
| curriculum          |            |          |              |       |
| available to        |            |          |              |       |
| prospective         |            |          |              |       |
| purchasers, the     |            |          |              |       |
| curriculum will not |            |          |              |       |
| be considered.      |            |          |              |       |
|                     |            |          |              |       |
| Format in which     |            |          |              |       |
| materials will      |            |          |              |       |
| continue to be made |            |          |              |       |
| available and costs |            |          |              |       |
| (insert dollar      |            |          |              |       |
| amount):            |            |          |              |       |
|                     |            |          |              |       |
| Print Cost:         |            |          |              |       |
| \$                  |            |          |              |       |
| [     ]{.underline} |            |          |              |       |
| Video Cost:         |            |          |              |       |
| \$                  |            |          |              |       |
| [     ]{.underline} |            |          |              |       |
| CD ROM Cost:        |            |          |              |       |
| \$                  |            |          |              |       |
| [     ]{.underline} |            |          |              |       |
|                     |            |          |              |       |
| DVD Cost:           |            |          |              |       |
| \$                  |            |          |              |       |
| [     ]{.underline} |            |          |              |       |
| Audiotapes Cost:    |            |          |              |       |
| \$                  |            |          |              |       |
| [     ]{.underline} |            |          |              |       |
| Electronic          |            |          |              |       |
| Cost:\$             |            |          |              |       |
| [     ]{.underline} |            |          |              |       |
|                     |            |          |              |       |
| Other               |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| **permanent         |            |          |              |       |
| state/university    |            |          |              |       |
| contact for this    |            |          |              |       |
| curriculum**        |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Name:               |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Title:              |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Unive               |            |          |              |       |
| rsity/Organization: |            |          |              |       |
|                     |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Address:            |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Phone:              | Fax:       |          | Email:       |       |
+---------------------+------------+----------+--------------+-------+
| **where can         |            |          |              |       |
| curriculum be       |            |          |              |       |
| obtained**          |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Name:               |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Title:              |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Unive               |            |          |              |       |
| rsity/Organization: |            |          |              |       |
|                     |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Address:            |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Phone:              | Fax:       |          | Email:       |       |
+---------------------+------------+----------+--------------+-------+
| **person submitting |            |          |              |       |
| application**       |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Name:               |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Title:              |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Unive               |            |          |              |       |
| rsity/Organization: |            |          |              |       |
|                     |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Address:            |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| Phone:              | Fax:       |          | Email:       |       |
+---------------------+------------+----------+--------------+-------+
| **Name and Title    |            | **S      |              | **Da  |
| (**type or          |            | ignature |              | te:** |
| print**):**         |            | :**      |              |       |
|                     |            |          |              |       |
| **     **           |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| **Principal         |            | **Sign   |              | **Da  |
| Investigator:**     |            | ature:** |              | te:** |
|                     |            |          |              |       |
| **     **           |            |          |              |       |
+---------------------+------------+----------+--------------+-------+
| **Authorized        |            | **Sign   |              | **Da  |
| Organizational      |            | ature:** |              | te:** |
| Representative:**   |            |          |              |       |
|                     |            |          |              |       |
| **     **           |            |          |              |       |
+---------------------+------------+----------+--------------+-------+

+----------------------------------+-----------------------------------+
| **Submission Instructions**      |                                   |
|                                  |                                   |
| A page break has been inserted   |                                   |
| so that the Submission           |                                   |
| Instructions will remain on one  |                                   |
| page and does not need to be     |                                   |
| submitted with the application.  |                                   |
+----------------------------------+-----------------------------------+
| Submit **One Electronic Copy**   |                                   |
| of this **Application Form** by  |                                   |
| 5:00 p.m., Eastern Daylight      |                                   |
| Time, **August 31, 2006** to:    |                                   |
| [**                              |                                   |
| natl4hjury@csrees.usda.gov**](ma |                                   |
| ilto:natl4hjury@csrees.usda.gov) |                                   |
|                                  |                                   |
| Submit **Eight (8) Hard Copies** |                                   |
| of the **Application Form** and  |                                   |
| **Eight (8) Hard Copies** of the |                                   |
| **Curriculum** (1 set full       |                                   |
| color; 7 sets can be black and   |                                   |
| white as long as they are good   |                                   |
| quality) by 5:00 p.m., Eastern   |                                   |
| Daylight Time, **August 31,      |                                   |
| 2006** to the following shipping |                                   |
| address (appropriate for express |                                   |
| services such as Federal         |                                   |
| Express, UPS, DHL, etc.):        |                                   |
|                                  |                                   |
| 4-H Curriculum Review            |                                   |
|                                  |                                   |
| Attn: Maria (Parisi) Arnold      |                                   |
|                                  |                                   |
| CSREES/USDA, Waterfront Centre   |                                   |
|                                  |                                   |
| 800 9^th^ Street, SW, Room 4311  |                                   |
|                                  |                                   |
| Washington, DC 20024             |                                   |
|                                  |                                   |
| \(202\) 720-8857                 |                                   |
|                                  |                                   |
| **Questions?** Contact National  |                                   |
| 4-H Headquarters, USDA at        |                                   |
| [**n                             |                                   |
| atl4hjury@csrees.usda.gov**](mai |                                   |
| lto:natl4hjury@csrees.usda.gov). |                                   |
| A jury review process team       |                                   |
| member will respond.             |                                   |
+----------------------------------+-----------------------------------+
| **team members**                 |                                   |
+----------------------------------+-----------------------------------+
| **Nancy Valentine, Ed.D.**       | -   Overall leadership for jury   |
|                                  |     review process and procedures |
| National Program Leader, 4-H     |                                   |
|                                  |                                   |
| 202-720-5347                     |                                   |
+----------------------------------+-----------------------------------+
| **Eddy Mentzer**                 | -   Coordination of review teams  |
|                                  |                                   |
| Program Specialist, 4-H          |                                   |
|                                  |                                   |
| 202-690-2086                     |                                   |
+----------------------------------+-----------------------------------+
| **Maria Arnold (Parisi)**        | -   Logistics and curriculum      |
|                                  |     coordination                  |
| Program Specialist, 4-H          |                                   |
|                                  |                                   |
| 202-720-8857                     |                                   |
+----------------------------------+-----------------------------------+
| **Cathann A. Kress, Ph.D.**      | -   Overall national leadership   |
|                                  |     for 4-H Youth Development     |
| Director of 4-H Youth            |     program                       |
| Development                      |                                   |
|                                  |                                   |
| 202-690-3009                     |                                   |
+----------------------------------+-----------------------------------+
| **general Information**          |                                   |
+----------------------------------+-----------------------------------+
| [http://www.nat                  | -   Application Forms for 4-H     |
| ional4hheadquarters.gov](http:// |     Jury Review                   |
| www.national4hheadquarters.gov/) |                                   |
|                                  | -   Intent to Submit Curriculum   |
|                                  |     Form                          |
|                                  |                                   |
|                                  | -   Checklist for submissions     |
|                                  |                                   |
|                                  | -   Tips and Guidelines           |
|                                  |                                   |
|                                  | -   National 4-H Jury Review      |
|                                  |     Criteria                      |
|                                  |                                   |
|                                  | -   Call for Reviewers            |
|                                  |                                   |
|                                  | -   Application for Reviewers     |
+----------------------------------+-----------------------------------+
| <Natl4hjury@csrees.usda.gov>     | -   E-mail address for questions  |
|                                  |     regarding curriculum review   |
+----------------------------------+-----------------------------------+

+--------------------+-------------------------------------------------+
| **2006 National    |                                                 |
| 4-H Curriculum     |                                                 |
| Jury Review**      |                                                 |
|                    |                                                 |
| **Certification of |                                                 |
| Professional       |                                                 |
| Editing**          |                                                 |
+--------------------+-------------------------------------------------+
| Name of Curriculum |                                                 |
+--------------------+-------------------------------------------------+
| Lead               |                                                 |
| Author/Principle   |                                                 |
| Investigator       |                                                 |
+--------------------+-------------------------------------------------+
| Unive              |                                                 |
| rsity/Organization |                                                 |
+--------------------+-------------------------------------------------+
| List of Materials  | 1\.                                             |
| Reviewed           |                                                 |
|                    | 2\.                                             |
|                    |                                                 |
|                    | 3\.                                             |
|                    |                                                 |
|                    | 4\.                                             |
|                    |                                                 |
|                    | (insert additional items as needed)             |
+--------------------+-------------------------------------------------+
| This is to certify |                                                 |
| that the above     |                                                 |
| print and          |                                                 |
| electronic         |                                                 |
| materials have     |                                                 |
| been reviewed and  |                                                 |
| edited and to the  |                                                 |
| best of our        |                                                 |
| knowledge:         |                                                 |
|                    |                                                 |
| -   Materials meet |                                                 |
|     current style  |                                                 |
|     standards and  |                                                 |
|     are free from  |                                                 |
|     typographical  |                                                 |
|     and            |                                                 |
|     grammatical    |                                                 |
|     errors         |                                                 |
|                    |                                                 |
| -   Photos and     |                                                 |
|     figures are    |                                                 |
|     appropriate    |                                                 |
|     and are not    |                                                 |
|     copyrighted,   |                                                 |
|     or if so, have |                                                 |
|     appropriate    |                                                 |
|     permissions    |                                                 |
|                    |                                                 |
| -   Permission     |                                                 |
|     slips that     |                                                 |
|     meet           |                                                 |
|     university     |                                                 |
|     policies are   |                                                 |
|     on file for    |                                                 |
|     all            |                                                 |
|     individuals in |                                                 |
|     photos         |                                                 |
|                    |                                                 |
| -   There are no   |                                                 |
|     references to  |                                                 |
|     commercial     |                                                 |
|     products or    |                                                 |
|     services. If   |                                                 |
|     it is          |                                                 |
|     absolutely     |                                                 |
|     necessary to   |                                                 |
|     reference a    |                                                 |
|     commercial     |                                                 |
|     product or     |                                                 |
|     service,       |                                                 |
|     appropriate    |                                                 |
|     permission has |                                                 |
|     been granted.  |                                                 |
|                    |                                                 |
| -   References and |                                                 |
|     citations to   |                                                 |
|     appropriate    |                                                 |
|     authors        |                                                 |
|     regarding the  |                                                 |
|     Experiential   |                                                 |
|     Learning Model |                                                 |
|     are used       |                                                 |
|                    |                                                 |
| -   Icons,         |                                                 |
|     figures, and   |                                                 |
|     headings are   |                                                 |
|     appropriate    |                                                 |
|                    |                                                 |
| -   Materials are  |                                                 |
|     culturally     |                                                 |
|     sensitive,     |                                                 |
|                    |                                                 |
| non-discriminatory |                                                 |
|     and free of    |                                                 |
|     stereotypes    |                                                 |
|                    |                                                 |
| -   Work by other  |                                                 |
|     authors have   |                                                 |
|     appropriate    |                                                 |
|     citations      |                                                 |
|                    |                                                 |
| -   Format,        |                                                 |
|     layout, and    |                                                 |
|     design are     |                                                 |
|     appropriate    |                                                 |
|     and pleasing   |                                                 |
+--------------------+-------------------------------------------------+
| **Editor:**        |                                                 |
|                    |                                                 |
| \_\_               |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
|                    |                                                 |
| Name (Print)       |                                                 |
|                    |                                                 |
| \_\_               |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
|                    |                                                 |
| Name (Signed)      |                                                 |
|                    |                                                 |
| \_\_               |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
|                    |                                                 |
| Title/Organization |                                                 |
|                    |                                                 |
| \_\_\_\_\_\_\_     |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_     |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
| \_\_\_\_\_\_\_\_\_ |                                                 |
|                    |                                                 |
| Phone Number Email |                                                 |
| Address            |                                                 |
|                    |                                                 |
| *Please print to   |                                                 |
| complete and       |                                                 |
| submit with        |                                                 |
| application form.* |                                                 |
+--------------------+-------------------------------------------------+