4-H Curriculum Proposal Form

This form is for committee use only!
(agents may view the form, but committee chairs must submit curriculum proposals for review)

4-H Curriculum Proposal
Proposals Due: January 15

1. Curriculum Title/Project

2. Proposal Contact

3. Academic or Regional Unit

4. Curriculum Committee Title(check title and subgroup where applicable)

Animal Sciences

Consumer and Family Sciences

Science/Technology

Environmental Ed./Earth Sciences

International/Diversity

Communication/Expressive Arts

Healthy Lifestyles Education

Leadership/Personal Development

Citizenship/Civic Education

5. Needs Statement(document needs assessment conducted)

6. Anticipated Enrollment

7. Audience(check audience(s))
4-H Youth
Other Youth
Volunteers
Parents/Guardians
Other

8. This project/curriculum is a

9. Project Goal

10. Project Curriculum Level is(choose all that apply)

Introductory/Beginner
Intermediate
Advanced

11. Life Skill Objectives(choose all that apply)

For more information and for evaluation tools on these objectives, visit:http://www.four-h.purdue.edu/fourfold/transition.html

Head
Utilizing Scientific Methods
Processing Information
Understanding Systems
Managing Resources
Practicing Creativity
Making Decisions
Solving Problems
Visualizing Information
Learning to Learn
Reasoning
Thinking Critically
Keeping Records
Planning and Organizing
Achieving Goals
Navigating in Your Environment
Working with Numbers

Hands
Mastering Technology
Learning Through Community Service
Volunteering
Being a Responsible Citizen
Working in a Team
Exercising Leadership
Completing a Project/Task
Motivating Yourself 		Heart
Communicating
Interacting Socially
Cooperating
Sharing
Resolving Conflicts
Valuing Social Justice
Valuing Diversity
Building Relationships
Caring for Others
Being Empathetic

Health
Being Responsible
Developing Self Esteem
Managing Yourself
Practicing Integrity and Character
Developing a Sense of Purpose
Developing a Positive View of Future
Utilizing Resistance Skills
Being Resilient
Managing Stress
Making Healthy Lifestyle Choices
Preventing Personal Injury
Expressing Emotions Positively
Preventing Disease

12a. Content Objectives

12b. This proposal supports objectives inPOW#

13. Proposed Delivery Method(i.e. project, curriculum guide, video, etc.)

14. Does Project/Curriculum proposal include development of a youth and a leader/helper guide or information?

Yes No

If no, please explain

15. Budget Proposal with Narrative(include estimated printing costs to cover the pilot printing and final printing)

16.Do you want this proposal considered for a grant from the Curriculum Innovation Fund(up to $1,000)?

Yes No

If yes, amount requested is .

List budget items for funding consideration:

17. Timeline

18. Evaluation Plan for collecting impact data

19. Other Considerations

20. Curriculum Committee Chair

21. Potential Project Funders (include contact information and/or address)



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