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Youth Group Enrollment Form

 

School        Teacher's Name 

Teacher's email 

Teacher's Tel ext #          Room #        Grade level 

Total number of youth in class  *

 

Racial/Ethnic background by gender

 
Female
Male
Total
White
White (Russian/Ukranianian)
Black/African American
Hispanic/Latino
Asian/Pacific Islander
Other
Total
*
*These numbers must match


Contact Jodie DuBois, 253.798.7193 for more information.

 
                         
                         
                         
 


Contact us:
253-798-7180| Accessibility | Copyright | Policies
Address: 3049 South 36th, Suite 300 Tacoma, WA 98409 | Driving Directions


Cooperating agencies: Washington State University, U.S Department of Agriculture, and Pierce County. Extension programs and employment are available to all without discrimination. Evidence of noncompliance may be reported through your local Extension office.