Jefferson County Master Gardener Volunteer Application

2612 Lane Park Road
Birmingham, Al 35223
Contact: Annette Drummonds
Phone: (205)879-6964         Email: ahd0001@aces.edu         Website: www.jeffcomg.org



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:
Zip/Postal Code:
 
Title:
Organization:
Work Street Address:
Address (cont.):
City:
State:
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 10 - 9? *                


Jefferson County Master Gardeners Association - Revised: 11/10/09
Alabama Cooperative Extension System programs are open to all, regardless of race, color, religion, sex, age, veteran status, national origin, disability, or political affiliation. Individuals with disabilities requiring assistance in the application process should make contact with Tony Glover at 205-879-6964 x 15. ACES is an Equal Opportunity/Affirmative Action employer.