Get Online Plan Request Form

Completing the Online Plan Request Form is an essential step for 4-H members with disabilities seeking accommodations. This guide walks you through each part of the form to ensure you provide all necessary information accurately.

Follow the steps to complete the Online Plan Request Form

1. Click the ‘Get Form’ button to access and open the Online Plan Request Form in your preferred editing tool.
2. In the field marked ‘4-H Member’s Name’, enter the full name of the member submitting the request.
3. Provide the age of the member as of January 1 of the current year in the respective field.
4. Input the member’s birth date in the designated date field.
5. Indicate the number of years the member has participated in 4-H activities.
6. Fill in the street address, city, state, and ZIP code for the member’s residence.
7. Enter the full name of the parent or guardian responsible for the member.
8. Include the contact phone number in the specified field.
9. Provide the email address of the parent or guardian.
10. Fill out the name of the 4-H club that the member is associated with.
11. Input the name(s) of the 4-H club advisor(s).
12. List the 4-H project(s) that the member is participating in for the current year.
13. Describe the member’s present level of needs and any current diagnosis in the respective section.
14. Outline the accommodations being requested to meet the member’s needs, including any specific procedures that the advisor should be aware of.
15. Read the agreement regarding the adherence to accommodations and the permission to share information. Then, provide the parent/guardian signature and date.
16. Once all sections are completed, save your changes, and you may choose to download, print, or share the form as needed.

Begin the process of submitting your Online Plan Request Form online today!