Skagit 4-H Volunteer Application

What county do you reside in? Choose from the dropdown menu:

Name

First Middle Last

Preferred Name

First Last

How may we refer to you?

she/her

he/him

they/them

Other

Would you like this to be included on your name tag, if available:

Yes

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone

Best way to reach me:

Telephone

Best time to call:

Morning

Afternoon

Evening

Please provide the name and information for your emergency contact:

Emergency Contact - Name

First Last

Emergency Contact - Relationship:

Emergency Contact - Phone:

Emergency Contact - Email:

Emergency Contact - Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please describe your experience or education/training (personal, volunteer, or work) working with youth, or if you have no experience/training, why you are interested in working with youth:

Age level(s) you prefer working with:(Required)

Elementary

Middle School

High School

Adult

What role are you interested in? Choose one of the dropdown choices:(Required)

What 4-H project areas are you interested in supporting:

If you marked other, specify projects of interest here:

Are you interested in volunteering within an existing 4-H Club or Program? If so, share the name of the club or program. If you are interested in starting something new, please tell us more.

In 4-H, volunteers are an essential part of the team. We value the unique skills, interests and experiences you bring. What talents would you be willing to share in support of the program?

If you marked other, please note here:

Description of specific skills, interest or experience:

If you are able to speak, read or write a language(s) other than English (including American Sign Language), please list here:

Why do you wish to become a WSU Extension 4-H Youth Development volunteer? For example, what do you hope to contribute or gain from participating in the WSU Extension 4-H Youth Development Program?

Is there any other information about your skills, knowledge, training, lived experiences, or abilities you would like to share with us?

Work, Education and Volunteer Experience (please provide most recent experience first):

Most Recent Work/Education/Experience - Name of Employer/Organization(Required)

Most Recent Work/Education/Experience - Position Title/Role(Required)

Most Recent Work/Education/Experience - Year(s)(Required)

References

List non-family members who have known you at least one year, and 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 e-mail addresses and phone numbers.

Reference #1 - Name

First Last

Reference #1 - Relationship to you(Required)

Reference #1 - Phone

Reference #1 - Email

Reference #1 - Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #2 - Name

First Last

Reference #2 - Relationship to you(Required)

Reference #2 - Phone

Reference #2 - Email

Reference #2 - Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Reference #3- Name

First Last

Reference #3 - Relationship to you(Required)

Reference #3 - Phone

Reference #3 - Email

Reference #3 - Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

I authorize Washington State University Extension to contact the listed references. I understand that a criminal background check is required prior to being fully accepted as a volunteer in the program. 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. During the final enrollment process, you will be instructed to provide agreement/choice to several volunteer policies and procedural items. You may review those items at: URL

In addition to the volunteer application and reference checks, other requirements for becoming a 4-H volunteer include an interview, self-paced online training, and background screening. Additional training is required for volunteers in specialized roles.

Your typed signature here will be accepted as a legitimate signature:(Required)

Extension programs and employment are available to all without discrimination. Evidence of noncompliance may be reported through your local Extension office. Persons with disabilities who require alternative means for communication or program information, or reasonable accommodation need to contact their local Extension office at least 2 weeks prior to the deadline for application.

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