WSU Extension > San Juan County WSU Extension > 4-H Program > Volunteer with 4-H > 4-H Volunteer Application 4-H Volunteer Application WSU 4-H Youth Development Volunteer Application Form Volunteer application to become a volunteer leader in Washington State 4-H Step 1 of 3 33% Name First Middle Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Length of time at current address PhoneBest time to call Email Enter Email Confirm Email 4-H Youth Development Program Club Leader Project Leader After School Programs Challenge School Enrichment Other If other, explain 4-H Project Areas of Interest Clothing & Textiles Environment Equine Expressive Arts Food & Nutrition Large Animals Mechanical Sciences Plant Sciences Small Animals Social Sciences Technology Other If other, explain Agriculture & Natural Resources Programs Beach Watchers Livestock Advisors Master Gardeners Other If other, explain Age level(s) you prefer working with 5-7 year olds 8-10 year olds 11-13 year olds 14-19 year olds Adults Please select any skills you have to contribute to the 4-H program Audiovisual operations Photography/videography Graphic arts Grant writing/fundraising Public speaking, teaching Writing and/or editing newsletters Public relations or marketing Web page design Carpentry/woodworking Clerical/office skills Food service Accounting, bookkeeping Leadership/management Facilitation Nursing/First Aid Research, data collection, experimentation Advocacy Computer skills Other Specific skills and talents are sometimes needed to enhance the quality of our programs.Other skills If you are able to communicate in a language other than English, please list Work, Education, and Volunteer Experience (please list one per line with most current experience first)Include Employer/Organization, Position Title/Volunteer Role and Year(s) for each line. Volunteer Consent and Agreement I agree to the following consents.Media Release: I understand that photos and video/audio recordings of me may be made during 4-H meetings, events and activities that maybe used in whole or in part by WSU Extension to promote the 4-H Youth Development Program Evaluations: I understand that youth and adult participants at 4-H meetings, events and activities may be asked to complete an evaluation. Completion of the evaluations is always optional. Training: If accepted as a WSU Volunteer in the 4-H Youth Development Program, I agree to complete the basic orientation and training program required of all WSU Extension 4-H Volunteers. In addition, I understand that additional training requirements may vary in each county and with specific volunteer positions. Former Name(s) Legal or Preferred Name(s) Date of Birth MM slash DD slash YYYY Driver's License Number Convicted of any crime against children or other person Yes No Explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.Convicted of crimes relating to financial exploitation if the victim was a vulnerable adult Yes No Explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.Convicted of crimes related to drugs as defined in RCW 43.43.830 Yes No Explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.Found in any dependency action under RCW 13.34.040 to have sexually assaulted or exploited any minor or to have physically abused any minor Yes No Explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.Found by a court in a domestic relations proceeding under Title 26 RCW to have sexually abused or exploited any minor or to have physically abused any minor Yes No Explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.Found in any disciplinary board final decision to have sexually or physically abused or exploited any minor or developmentally disabled person or to have abused or financially exploited any vulnerable adult Yes No Explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.Found by a court in a protection proceeding under chapter 74.34 RCW, to have abused or financially exploited a vulnerable adult. Yes No Explain in the area provided, indicating the charge or finding, the date, and the court(s) involved.Please note: A criminal record will be considered as it relates to specifics of the volunteer position for which you are applying. A criminal record may prevent an individual from volunteering, depending on the nature of the offense. Personal ReferencesReferences: List non-family members who have knowledge of your skills, abilities, and qualifications. Individuals should have worked with you on projects and activities and/or have direct experience with or knowledge of your qualifications. Please provide complete addresses and phone numbers.Reference 1Please provide the information for your first reference:Name First Last Relationship to you Home PhoneCell PhoneEmail Reference 2Please provide the information for your second reference:Name First Last Relationship to you Home PhoneCell PhoneEmail Reference 3Please provide the information for your third reference:Name First Last Relationship to you Home PhoneCell PhoneEmail Consent(Required) I agree to the following statement and authorize a background check.I authorize the contact of listed references and understand a criminal background check will be completed prior to final consideration of my application to volunteer. I understand that misrepresentation or omission of required information is just cause for non-appointment as a volunteer with Washington State University Extension. I understand that I serve at the pleasure of the Washington State University Extension and agree to abide by the policies of Washington State University Extension and individual program areas and to fulfill the volunteer responsibilities to the best of my ability. Δ