Volunteer Application
Cornell Cooperative Extension Sullivan County Gerald J. Skoda Extension Education Center 64 Ferndale-Loomis Road Liberty, NY 12754 p: 845-292-6180 f: 845-292-4946 e: [email protected] w: www.sullivancce.org
Master Gardener Volunteer Application Instructions **Application deadline for Master Gardener Volunteer Training is June 1, 2016 ** Please fill out the following: 1. Volunteer Application including two personal references. 2. Authorization Form for Criminal Background Check. Master Gardener Volunteers are required to have a criminal background check upon acceptance to the program. It is included for your review.
Please mail back with only your “Name” filled out. 3. Master Gardener Volunteer Training Questionnaire 4. Please return the completed application to Dayna Valenti-Gaeta, Community Horticulture Program Educator: Cornell Cooperative Extension of Sullivan County, 64 Ferndale-Loomis Road, Liberty, NY 12754 . Alternately, you may scan and email the application to [email protected]. 5. The interview process will take place during June and July. Participants will be notified of acceptance by the middle of August, 2016. The course fee is $300, which includes a Master Gardener Manual. This must be paid in full by the start of the class. Scholarships are available based on need. Thank you for your interest in our Master Gardener Volunteer Program!
.
Cornell Cooperative Extension Sullivan County Gerald J. Skoda Extension Education Center 64 Ferndale-Loomis Road Liberty, NY 12754 p: 845-292-6180 f: 845-292-4946 e: [email protected] w: www.sullivancce.org
Volunteer Application Directions:
*Type or print *If you need additional space, attach a separate sheet *Sign the completed application
GENERAL NAME (Last)
First
Mailing Address - Street
Today’s Date
Middle
Phone #’s
E-Mail Address - Day - Cell
City
State
Have you ever volunteered for CCE before? Yes
Zip Code Social Security #
Date of Birth
If yes, give dates, program, position
Date available? Approximately when and how many hours/week would you From To like to volunteer? VOLUNTEER POSITION: Please check the volunteer role(s) that interest you most. _____ 4-H Leader _____ Organizing events/activities _____ Master Gardener _____ Program development _____ Master Food Preserver _____ Consumer Outreach _____ Marketing the organization _____ Resource development – fund raising _____ Organizational Development (advising & assisting with _____ Other: (please specify) _______________________ programs.) ________________________________________________ _____ Master Forester What interests do you wish to pursue or what do you hope to accomplish by serving as a CCE volunteer?
List your volunteer, paid, or educational experiences that relate to the volunteer position you seek Organization/Employer Position/Activity
Dates
Describe any education or training that you have had related to the volunteer position you seek. Also describe any special skills, experiences, or interests along with hobbies, licenses, certifications, or other interests you consider relevant.
.
Accommodations: Given the expectations of the volunteer position for which you are applying, describe any physical or health accommodations that may be needed to allow you to participate in the activity. __________________________
Transportation: Do you have an independent and reliable means of transportation to and from volunteer activities? _____ Yes _____ No REFERENCES: List 2 people, not related to you, that we may contact who have knowledge of your qualifications. Please provide complete addresses. Name Mailing Address Daytime Phone #
Have you ever been convicted of a criminal offense other than a minor traffic violation? _____ No _____Yes (If yes) Date(s) NOTE: A criminal record will not necessarily bar an applicant. A criminal record will be considered as it relates to the requirements of the volunteer position for which you have expressed an interest. Do you possess a valid NYS Driver’s License? ____ Yes ____ No Drivers License # ________________ NOTE: If the volunteer position you seek requires the transportation of others in your personal vehicle or use of CCE Association vehicles, you will be asked to complete a motor vehicle record request permission form.
I affirm that the statements made on this application are true. I understand that misrepresentation or omission of facts requested is cause for my non-appointment or removal as a Cornell Cooperative Extension volunteer. I authorize Cornell Cooperative Extension of _______________ County to obtain from all persons, including those not named here, and/or agencies any records, documents, and other information relative to my suitability to perform the duties of the volunteer position. I understand, if the volunteer position I seek involves unsupervised work with minors, individuals over 65, or individuals with disabilities that a criminal background check including a sexual offender search will be made. I further release all parties supplying said information from all liability and responsibility arising from their supplying said information. I understand and agree that the volunteer position at CCE for which I am applying, is without compensation or benefits of any kind. I further understand that the provisions of this application do not constitute a contract (either expressed or implied) of employment between myself and CCE. I further understand and agree that if I am offered and accept a volunteer position at CCE, either I or CCE, may terminate the volunteer relationship at any time for any reason or for no particular reason or cause. CCE reserves the right to determine and change its policies and procedures applicable to volunteers at any time for any reason. I understand and agree that my volunteer position is contingent upon, among other things, my signing the CCE Association Volunteer Agreement and acceptance of the provisions of the CCE Association Volunteer Code of Conduct. Signature
.
Date
Cornell Cooperative Extension Sullivan County Gerald J. Skoda Extension Education Center 64 Ferndale-Loomis Road Liberty, NY 12754 p: 845-292-6180 f: 845-292-4946 e: [email protected] w: www.sullivancce.org
Master Gardener Volunteer Training Questionnaire Please fill out and return with your application for Master Gardner Volunteer Training. Name __________________________________________ Phone Number______________________ Address _____________________________________City_________________Zip_______________ 1. Why do you want to be a Master Gardener Volunteer in Sullivan County, NY? ________________ ________________________________________________________________________________ 2. What are your particular areas of gardening interest? ____________________________________ 3. Are you presently employed? _______ What type of work do you do? ______________________ 4. If you are retired, what type of work did you do? _________________________________________ 5. Describe any special talents you have that would make you helpful as a Master Gardener Volunteer (ex. Speaking, gardening, construction, teaching, etc)______________________________________ __________________________________________________________________________________ 6. Are you able to perform the essential functions of gardening, with or without reasonable accommodations?___________________________________________________________________ *If I am accepted into the Program, I agree to: Attend all Master Gardener Training Classes
Yes ____ No ____
Fulfill the volunteer commitment of 80 hours over two years
Yes ____ No ____
Attend at least 4 monthly meetings per year
Yes ____ No ____
Participate in projects, scheduled work days, lectures, etc.
Yes ____ No ____
Applicant’s Signature ___________________________________________ Date _________ Building Strong and Vibrant New York Communities Cornell Cooperative Extension in Sullivan County is an employer and educator recognized for valuing AA/EEO, Protected Veterans, and Individuals with Disabilities and provides equal program and employment opportunities. Please contact the Cornell Cooperative Extension Sullivan County office if you have any special needs. .
Tentative MGV Training Schedule Fall 2016 Date
Time and Location
Topic
September 9
CCE Sullivan 1:00-6:00PM
Intro/Orientation
September 23
CCE Sullivan 1:00-6:00PM
Garden Botany/ Morphology/Taxonomy
October 14
CCE Sullivan 1:00-6:00PM
Soils/ Fertilizers
October 28
CCE Sullivan (1:00-6:00)
Tree Fruit/Small Fruit
November 10 (Thursday)
CCE ORANGE (9 - 3)
Wildlife Management
November 18
CCE Sullivan 1:00-6:00PM
Pathology/Plant Disease
December 2
CCE Sullivan 1:00-6:00PM
Houseplants/ Plant Propagation/Cactus/Succulents
December 16
CCE Sullivan 1:00-6:00PM
Forest Owners/ Composting
January 13
CCE Sullivan 1:00-6:00PM
Garden Design/Veggies/Herbs
January 27
CCE Sullivan 1:00-6:00PM
Annuals and Perennials and Weeds
February 10
CCE Sullivan 1:00-6:00PM
Pest Management/Entomology
February 24
CCE Sullivan 1:00-6:00PM
Helpline & Lab
March 10
CCE Sullivan 1:00-6:00PM
Pruning/ Invasives
March 24
CCE Sullivan 1:00-6:00PM
Graduation (and Snow date if needed)
April 7
Snow date TBD
*Topics are tentative based on the scheduling of instructors. Please look over the schedule and be sure that you can attend on these dates. You may not miss any classes. If we have more than one cancellation due to weather, we will determine another date. .
Master Gardener Volunteer Application Instructions **Application deadline for Master Gardener Volunteer Training is June 1, 2016 ** Please fill out the following: 1. Volunteer Application including two personal references. 2. Authorization Form for Criminal Background Check. Master Gardener Volunteers are required to have a criminal background check upon acceptance to the program. It is included for your review.
Please mail back with only your “Name” filled out. 3. Master Gardener Volunteer Training Questionnaire 4. Please return the completed application to Dayna Valenti-Gaeta, Community Horticulture Program Educator: Cornell Cooperative Extension of Sullivan County, 64 Ferndale-Loomis Road, Liberty, NY 12754 . Alternately, you may scan and email the application to [email protected]. 5. The interview process will take place during June and July. Participants will be notified of acceptance by the middle of August, 2016. The course fee is $300, which includes a Master Gardener Manual. This must be paid in full by the start of the class. Scholarships are available based on need. Thank you for your interest in our Master Gardener Volunteer Program!
.
Cornell Cooperative Extension Sullivan County Gerald J. Skoda Extension Education Center 64 Ferndale-Loomis Road Liberty, NY 12754 p: 845-292-6180 f: 845-292-4946 e: [email protected] w: www.sullivancce.org
Volunteer Application Directions:
*Type or print *If you need additional space, attach a separate sheet *Sign the completed application
GENERAL NAME (Last)
First
Mailing Address - Street
Today’s Date
Middle
Phone #’s
E-Mail Address - Day - Cell
City
State
Have you ever volunteered for CCE before? Yes
Zip Code Social Security #
Date of Birth
If yes, give dates, program, position
Date available? Approximately when and how many hours/week would you From To like to volunteer? VOLUNTEER POSITION: Please check the volunteer role(s) that interest you most. _____ 4-H Leader _____ Organizing events/activities _____ Master Gardener _____ Program development _____ Master Food Preserver _____ Consumer Outreach _____ Marketing the organization _____ Resource development – fund raising _____ Organizational Development (advising & assisting with _____ Other: (please specify) _______________________ programs.) ________________________________________________ _____ Master Forester What interests do you wish to pursue or what do you hope to accomplish by serving as a CCE volunteer?
List your volunteer, paid, or educational experiences that relate to the volunteer position you seek Organization/Employer Position/Activity
Dates
Describe any education or training that you have had related to the volunteer position you seek. Also describe any special skills, experiences, or interests along with hobbies, licenses, certifications, or other interests you consider relevant.
.
Accommodations: Given the expectations of the volunteer position for which you are applying, describe any physical or health accommodations that may be needed to allow you to participate in the activity. __________________________
Transportation: Do you have an independent and reliable means of transportation to and from volunteer activities? _____ Yes _____ No REFERENCES: List 2 people, not related to you, that we may contact who have knowledge of your qualifications. Please provide complete addresses. Name Mailing Address Daytime Phone #
Have you ever been convicted of a criminal offense other than a minor traffic violation? _____ No _____Yes (If yes) Date(s) NOTE: A criminal record will not necessarily bar an applicant. A criminal record will be considered as it relates to the requirements of the volunteer position for which you have expressed an interest. Do you possess a valid NYS Driver’s License? ____ Yes ____ No Drivers License # ________________ NOTE: If the volunteer position you seek requires the transportation of others in your personal vehicle or use of CCE Association vehicles, you will be asked to complete a motor vehicle record request permission form.
I affirm that the statements made on this application are true. I understand that misrepresentation or omission of facts requested is cause for my non-appointment or removal as a Cornell Cooperative Extension volunteer. I authorize Cornell Cooperative Extension of _______________ County to obtain from all persons, including those not named here, and/or agencies any records, documents, and other information relative to my suitability to perform the duties of the volunteer position. I understand, if the volunteer position I seek involves unsupervised work with minors, individuals over 65, or individuals with disabilities that a criminal background check including a sexual offender search will be made. I further release all parties supplying said information from all liability and responsibility arising from their supplying said information. I understand and agree that the volunteer position at CCE for which I am applying, is without compensation or benefits of any kind. I further understand that the provisions of this application do not constitute a contract (either expressed or implied) of employment between myself and CCE. I further understand and agree that if I am offered and accept a volunteer position at CCE, either I or CCE, may terminate the volunteer relationship at any time for any reason or for no particular reason or cause. CCE reserves the right to determine and change its policies and procedures applicable to volunteers at any time for any reason. I understand and agree that my volunteer position is contingent upon, among other things, my signing the CCE Association Volunteer Agreement and acceptance of the provisions of the CCE Association Volunteer Code of Conduct. Signature
.
Date
Cornell Cooperative Extension Sullivan County Gerald J. Skoda Extension Education Center 64 Ferndale-Loomis Road Liberty, NY 12754 p: 845-292-6180 f: 845-292-4946 e: [email protected] w: www.sullivancce.org
Master Gardener Volunteer Training Questionnaire Please fill out and return with your application for Master Gardner Volunteer Training. Name __________________________________________ Phone Number______________________ Address _____________________________________City_________________Zip_______________ 1. Why do you want to be a Master Gardener Volunteer in Sullivan County, NY? ________________ ________________________________________________________________________________ 2. What are your particular areas of gardening interest? ____________________________________ 3. Are you presently employed? _______ What type of work do you do? ______________________ 4. If you are retired, what type of work did you do? _________________________________________ 5. Describe any special talents you have that would make you helpful as a Master Gardener Volunteer (ex. Speaking, gardening, construction, teaching, etc)______________________________________ __________________________________________________________________________________ 6. Are you able to perform the essential functions of gardening, with or without reasonable accommodations?___________________________________________________________________ *If I am accepted into the Program, I agree to: Attend all Master Gardener Training Classes
Yes ____ No ____
Fulfill the volunteer commitment of 80 hours over two years
Yes ____ No ____
Attend at least 4 monthly meetings per year
Yes ____ No ____
Participate in projects, scheduled work days, lectures, etc.
Yes ____ No ____
Applicant’s Signature ___________________________________________ Date _________ Building Strong and Vibrant New York Communities Cornell Cooperative Extension in Sullivan County is an employer and educator recognized for valuing AA/EEO, Protected Veterans, and Individuals with Disabilities and provides equal program and employment opportunities. Please contact the Cornell Cooperative Extension Sullivan County office if you have any special needs. .
Tentative MGV Training Schedule Fall 2016 Date
Time and Location
Topic
September 9
CCE Sullivan 1:00-6:00PM
Intro/Orientation
September 23
CCE Sullivan 1:00-6:00PM
Garden Botany/ Morphology/Taxonomy
October 14
CCE Sullivan 1:00-6:00PM
Soils/ Fertilizers
October 28
CCE Sullivan (1:00-6:00)
Tree Fruit/Small Fruit
November 10 (Thursday)
CCE ORANGE (9 - 3)
Wildlife Management
November 18
CCE Sullivan 1:00-6:00PM
Pathology/Plant Disease
December 2
CCE Sullivan 1:00-6:00PM
Houseplants/ Plant Propagation/Cactus/Succulents
December 16
CCE Sullivan 1:00-6:00PM
Forest Owners/ Composting
January 13
CCE Sullivan 1:00-6:00PM
Garden Design/Veggies/Herbs
January 27
CCE Sullivan 1:00-6:00PM
Annuals and Perennials and Weeds
February 10
CCE Sullivan 1:00-6:00PM
Pest Management/Entomology
February 24
CCE Sullivan 1:00-6:00PM
Helpline & Lab
March 10
CCE Sullivan 1:00-6:00PM
Pruning/ Invasives
March 24
CCE Sullivan 1:00-6:00PM
Graduation (and Snow date if needed)
April 7
Snow date TBD
*Topics are tentative based on the scheduling of instructors. Please look over the schedule and be sure that you can attend on these dates. You may not miss any classes. If we have more than one cancellation due to weather, we will determine another date. .
