Registrations | Illinois Extension

We're so excited that you're ready to become a 4-H Teen Teacher! Please complete the application below so we can learn more about your unique skills and talents!

Contact Information

First Name

Last Name

Street Address

Street Address 2

City

State

ZIP

Daytime Phone

Evening Phone

E-mail Address

What county do you live in?

What's your cell phone number? We will only use this information for communication about the Teen Teacher program. We will not provide this information to anyone else.

Is it okay to text?

Yes

How old are you currently?

Other

What grade are you in?

Photo Release I, the undersigned, do hereby consent to the use by The Board of Trustees of the University of Illinois (University) of my image, voice, or both described below, in (1) the video, photograph, or audio recording described below; and (2) any video, photograph, or audio recording reproduced either in whole or in part from the video, photograph or audio recording described below: regardless of whether these materials are used for fundraising, advertising, publicity, or any other purpose on behalf of either the University or its Foundation. I warrant that I have the full right and authority to grant this consent. In addition, I waive all claims to compensation or damages based on the use of my image or voice, or both, by either the University or the Foundation. I also waive any right to inspect or approve the finished photograph or video or audio recording. I understand that this consent is perpetual, that I may not revoke it, and that it is binding on me, my heirs and assigns. I warrant that I am at least 18 years of age and that I am competent in my own name insofar as this consent is concerned, or that I am the parent or legal guardian authorized to sign on behalf of a person under age 18. I further attest that I have read this consent form and fully understand its contents.

YES

What school do you attend?

Are you currently involved in 4-H? If so, how?

Parent/Guardian Name

Parent/Guardian Cell Phone We will only use this information for communication about the Teen Teacher program. We will not provide this information to anyone else.

Parent/Guardian Email We will only use this information for communication about the Teen Teacher program. We will not provide this information to anyone else.

What topics would you most like to teach to younger youth? (Please select all that apply.) You can change your mind later.

STEM (Science, Technology, Engineering, & Math)

Health, Food & Nutrition (Fitness, Healthy Eating, Cooking, etc.)

Wellness (Mindfulness, Mental/Social/Emotional Health, etc.)

Arts & Crafts

Citizenship (Community Engagement, Different Cultures, Service, etc.)

Agriculture/Nature/Environment (Climate Change, Plants & Animals, etc.)

Other

Why do you want to be a 4-H Teen Teacher?

What skills and qualities do you bring that you think will help you be an effective Teen Teacher?

Civil Rights Compliance - Participant Info

As part of our commitment to providing equal opportunities in our programming, University of Illinois Extension is required to collect and report overall statistics about the race, ethnicity, and gender of program participants. Your responses are voluntary and appreciated.

Gender

Ethnicity

Race

Teen Teacher Application

Already have an Extension User Account?

Contact Information

Civil Rights Compliance - Participant Info