Jefferson County Master Gardener Volunteer Application

Please provide the following personal information:

First Name:	*	* = Required Fields
Middle Initial:
Last Name:	*
E-mail:	*
Confirm E-mail:	*
Area Code & Phone:	*
Street Address:
Address (cont.):
City:
State:	AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip/Postal Code:
Title:
Organization:
Work Street Address:
Address (cont.):
City:
State:	AL AK AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY
Zip/Postal Code:
Work Area Code & Phone:
FAX:

Please answer the following questions:

May we contact you at work? Yes or No

Are you employed by a horticultural business? Yes or No

Are you a resident of Jefferson County? Yes or No

Are you a government employee? Yes or No

Are you interested in this course for your employment? Yes or No

Did a Master Gardener Volunteer refer you? Yes or No

If Yes, please advise who referred you:

Do you speak a non-English language? Yes or No

If Yes, What Other language(s):

Do you fluently speak and write this language? Yes or No

Do you have an interest in learning about or have gardening experience in the following areas? Check all that apply.

Water Gardening	Garden Design	Composting
Perennials	Vegetable Gardens	Houseplants
Organic Gardening	Tree / Shrub Production	Roses
Wildflowers	Lawn Care	Wetland Plantings
Home Fruit / Orchard	Plant Propagation	Wildlife Habitat
Herbs	Insects	Flower Arranging
Native Plants	Butterfly Gardens	Diseases / Pathology

Horticultural Experience

Please check the description that best describes you:
Beginner home gardener
Experienced home gardener
Horticulture professional or govt. employee
Specialty gardener (ex: orchids, fruit trees)
Specialty?

Which activities do you enjoy? (Check all that apply)

Walking / Hiking	Computers	Preservation
Canning Food	Film Photography	Writing Articles
Digital Photography	Travel	Garden Tours
Working With Youth	Cooking	Craft Projects
Fundraising	Coordinating Special Media	Publicity Work
Working With Elderly	Birdwatching	Scientific Research
Planning New Projects	Insect Study	Public Speaking

Volunteer Experience:

Are you aware of the volunteer commitment associated with the Master Gardener Volunteer program?

Yes or No

(Volunteer commitment is currently 50 hours the first year, 25 hours each subsequent year plus 10 hours of continuing education and the cost of this 13 week course which meets one day per week is $200)

Do you currently volunteer? Yes or No

If yes, where do you volunteer?

If yes, list 3 past volunteer activities:

How do you plan on using your Jefferson County Master Gardener Volunteer training?

Do you have any questions or comments?

Have you ever been convicted of a felony?*   Yes or No (Note: a criminal record does not necessarily disqualify your application.)

* = Required Fields

Please list three references (name and contact details) who can offer support of your application.*

Name:	Address:	Phone:
			*
			*
			*

SPAM prevention question: What is 8 - 2? *