WSU Extension 4-H STEM Kit Reservation

Organization/Club Name(Required)

Requester's Name(Required)

First Last

Email(Required)

Address of Activity(Required)

Street Address City

STEM Kit Requesting(Required)

Estimated number of youths for this kit?(Required)

Have you used this kit before?(Required)

Yes

Maybe

Date Needed(Required)

Date Returning(Required)

Would like to request another STEM Kit?

Yes

Second STEM Kit Requesting(Required)

Estimated number of youths for this kit?(Required)

Have you used this kit before?(Required)

Yes

Maybe

Second Kit Date Needed (if different than the first kit)(Required)

Second Kit Date Returning (if different than the first kit)(Required)

Would like to request a third STEM Kit?(Required)

Yes

Third STEM Kit Requesting(Required)

Estimated number of youths for this kit?(Required)

Have you used this kit before?(Required)

Yes

Maybe

Third Kit Date Needed(Required)

Third Kit Date Returning (if different than the first kit)(Required)

Would like to request a Fourth STEM Kit?(Required)

Yes

Fourth STEM Kit Requesting(Required)

Estimated number of youths for this kit?(Required)

Have you used this kit before?(Required)

Yes

Maybe

Fourth Kit Date Needed (if different than the first kit)(Required)

Fourth Kit Date Returning (if different than the first kit)(Required)

Would like to request a Fifth STEM Kit?(Required)

Yes

Fifth STEM Kit Requesting(Required)

Estimated number of youths for this kit?(Required)

Have you used this kit before?(Required)

Yes

Maybe

Fifth Kit Date Needed (if different than the first kit)(Required)

Fifth Kit Date Returning (if different than the first kit)(Required)

Would like to request a Sixth STEM Kit?(Required)

Yes

Fifth STEM Kit Requesting(Required)

Estimated number of youths for this kit?(Required)

Have you used this kit before?(Required)

Yes

Maybe

Sixth Kit Date Needed (if different than the first kit)(Required)

Sixth Kit Date Returning (if different than the first kit)(Required)

Training and Use

Each kit includes activity instruction. However, WSU Trainers can help you think about tailoring the kits to you and your youths' needs. Do you want free training?(Required)

Yes

Preferred days and times for training.

Please let us know your plan for using these WSU Extension Pierce County 4-H provided STEM Kits.(Required)

Youth Demographics

Please share some information about the young people who will have access to the kit(s). You will receive a more detailed demographic form to complete for our records once you have the kits at your program.

Number of Youth(Required)

Ages of Youth(Required)

4-H STEM Kit Reservation Form

Training and Use

Youth Demographics