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[" YOUTH ATTENDANCE RECORD/SIGN-IN SHEETS"]
[{"$nulls":15},"AFFACT-08.2"]
[null,"Name of Program/Event:",{"$nulls":4},"Date:",{"$nulls":9},"2014-10-01"]
[null,"Location:",{"$nulls":4},"Conducted by:",null,null,"    "]
[null,"Hours of Instruction:          __________________________________________________",{"$nulls":4},"Teacher/Leader:         _______________________________________________"]
[null,"Delivery Mode:                   __________________________________________________",{"$nulls":4},"Duplicate Audience?",null,null,"Yes","No"]
[]
[{"$nulls":5},"*Ethnicity                              (Please Check One)",null,null,"* Race                                                                                  (Please Check One)",{"$nulls":6},"* Gender"]
[null," Youth Name ",null,"Age","Grade","Hispanic/ Latino","Non-Hispanic/ Latino",null,"White ","Black ","Hawaiian/ Pacific Islander","American Indian / Alaskan Native","Asian","Two or More Races",null,"Female","Male"]
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[5,{"$nulls":9}," "]
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["* This information is requested solely for the purpose of determining compliance with federal civil rights "]
["law, and your response will not affect your eligibility to participate in Extension programs.  By providing"]
["this information, you will assist us in assuring that this program is administered in a nondiscriminatory manner."]
["The Arkansas Cooperative Extension Service offers its programs to all eligible persons regardless of race, color, sex, gender identity, sexual orientation, national origin, religion, age, disability, marital or veteran status, genetic information, or any other legally protected status, and is an Affirmative Action/Equal Opportunity Employer.                                                                                                                                                                 "]