Application for Master Gardeners

Ohio State University Extension

Master Gardener Volunteer Application Form

(All sections must be completed for consideration as a Master Gardener Volunteer)

I. GENERAL INFORMATION

Name:

___________________________________________________________

(First) (Middle) (Last)

Mailing Address:

______________________________________________________________________

(Street) (City) (Zip)

Phone: Day: ( ) ________________________

Best Time to Call: __________

Eve: ( ) ________________________

Best Time to Call: __________

Email:________________________________________

Length of time at this address (years): ____________

Date of Birth (MM/DD/YY):___________________

Please check the appropriate box (this is for tracking demographic information only).

Highest degree completed:

□ High School

□ Technical Degree

□ Undergraduate Degree

□ Graduate Degree

□ Professional Degree

Have you participated in Ohio State University Extension activities or programs previously? (list most recent involvement)_____________________________________________________________

___________________________________________________________________________________

If you have been a Master Gardener Volunteer in another state, please list the state, county, year of training, and program supervisor’s name: ___________________________________________

___________________________________________________________________________________

II. VOLUNTEER INTEREST

Why are you interested in becoming a Master Gardener Volunteer?

_________________________________________________________________________

___________________________________________________________________________________

What is your gardening philosophy?

___________________________________________________________________________________

Previous Work Experience: (List current or most recent experience first)

Employer Position Title Year

___________________________________________________________________________________

______________________________________________________________________________________________________________________________________________________________________

Previous Volunteer Experience: (List current or most recent experience first)

Organization Volunteer Role Year

___________________________________________________________________________________

Other special skills, training, interests (i.e. birdwatching, crafts, desktop publishing, etc.): ______

___________________________________________________________________________________

Type of activities in which you are interested:

o Garden Hotline o Public Presentations o Community Gardens

o Demonstration Gardens o Working with Children o Working with Adults

o Beautification Projects o Garden Writing o Therapeutic Hort.

o Other interests_______________________________________________

Indicate days and times you are available to volunteer:

Monday morning_____ afternoon_____ evening_____

Tuesday morning_____ afternoon_____ evening_____

Wednesday morning_____ afternoon_____ evening_____

Thursday morning_____ afternoon_____ evening_____

Friday morning_____ afternoon_____ evening_____

Saturday morning_____ afternoon_____ evening_____

We frequently have many more applicants than volunteer positions, and consequently must choose among equally qualified individuals. Please explain why you think you would make a good Master Gardener Volunteer:

___________________________________________________________________________________

III. PERSONAL REFERENCES

Have you ever been convicted of a misdemeanor or a felony? _____________

If yes, please give date, nature, and disposition of offense:

___________________________________________

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.

References: 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.

Name: ______________________________________________________

Relationship:_______________________________

           Home Phone __________________________


          Work Phone___________________________

Address:___________________________________________________

(Street) (City) (State) (Zip)

Name: _____________________________________________________

Relationship: ______________________________

Home Phone ________________________

Work Phone _________________________

Address: _____________________________________________________________

(Street) (City) (State) (Zip)

Name: ___________________________________________________

Relationship: __________________________________________

Home Phone _________________________

Work Phone _________________________

Address: ___________________________________________________________

(Street) (City) (State) (Zip)

I authorize the contact of listed references and understand that I am required to submit to a fingerprint criminal background check 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 Ohio State University Extension. I understand that I serve at the pleasure of the Ohio State University Extension and agree to abide by the policies of Ohio State University Extension and individual program areas and to fulfill the volunteer responsibilities to the best of my ability.

Applicant Signature: ____________________________________________

Date: _______________________

Please return completed application to tilton.3@osu.edu
or by mail to 1495 Longview Avenue, Suite 206, Mansfield, OH 44906.
Contact us if you have any questions or wish further information.
419-747-8755

Thank you!

Ohio State University Extension embraces human diversity and is committed to ensuring that all research and related educational programs are available to clientele on a
nondiscriminatory basis without regard to race, color, religion, sex, age, national origin,
sexual orientation, gender identity or expression, disability, or veteran status. This
statement is in accordance with United States Civil Rights Laws and the USDA.

Keith L. Smith, Ph.D., Associate Vice President for Agricultural Administration and Director, Ohio State University Extension TDD No. 800-589-8292 (Ohio only) or 614-292-1868

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