4-H Volunteer Application

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1 Oklahoma Volunteer Management System If you have any questions about this process; contact your county Extension educator or the State 4-H Office (405) Four-H volunteers provide leadership and service to the community by assisting youth in developing life skills and civic responsibility. Quality leadership is important in the development of capable 4-H members. This application provides the 4-H program an opportunity to select individuals best suited for leadership roles necessary for furnishing youth with a quality educational experience. Thank you for your interest in sharing your time, talents and resources with the Oklahoma 4-H program. Volunteers and the 4-H Program Volunteers are an integral part of the Oklahoma Cooperative Extension Service 4-H Youth Development team who do not receive monitorial compensation. Volunteers team with Extension Educators to enable 4-H youth development programs to reach larger numbers of youth and adults through programming efforts. The purpose for volunteer certification is four-fold: To ensure a safe environment for youth involved in Oklahoma Cooperative Extension Service 4-H Youth Development programs; To provide documentation of volunteer activities in Oklahoma 4-H programs and to strengthen liability coverage for volunteers under the State of Oklahoma Governmental Tort Claims Act; To assist in the selection, tracking and placement of volunteers in Oklahoma 4-H Youth Development programs. To develop 4-H volunteer competencies through continuing education activities. Civil Rights Oklahoma Cooperative Extension Service programs provide opportunities for all citizens, without discrimination on the basis of race, color, national origin, genetic information, sex, age, sexual orientation, gender identity, religion, disability, or status as a veteran, in any of its policies, practices or procedures. The Mission of Oklahoma 4-H The mission of Oklahoma 4-H Youth Development is to provide Oklahoma youth, families, and communities with educational programs which will create an environment for diverse audiences of youth and adults to reach their fullest potential by developing and enhancing skills for living. 4-H VISION Oklahoma 4-H is a national leader in developing youths abilities to become productive citizens and catalysts for positive change, meeting the needs of a diverse and changing society. Through 4-H youth development education, youth will: Feel valued and empowered as a resource in the community. Practice effective problem solving and decision making skills. Be environmental stewards. Demonstrate positive character and ethical behavior. Appreciate human differences. Have a strong sense of community and social responsibility. Contribute to positive relationships with families, peers, and community. Demonstrate communication and leadership skills. Value lifelong learning. Feel the personal pride that comes from mastery. Certification Steps If you are interested in working with 4-H youth as an organizational leader, a project club leader, a chaperone or in any situation that is unsupervised by staff or a certified volunteer, this application must be completed. 4-H volunteers and extension staff may recruit potential volunteers; however, the OCES staff in cooperation with the county Volunteer Advisory Committee must approve all volunteers. To become a volunteer in the Oklahoma 4-H Program, a person is required to: 1. Complete Volunteer Application. The application aids in gathering information used to verify instances where a legitimate question arises as to the applicant s qualification. 2. Attend/participate in the OK 4-H Youth Development Orientation, OSU/4-H Working with Minors Training and Title VII/IX Training. 3. Annually complete a minimum of four continuing education units/parent-volunteer trainings and renew Working with Minors and Title VII/IX Training. 4. Volunteers working with some grant funded programs will be required to pass an OSBI background check. In the event of a 3-year break in service (inactive and/or not completing required training) an individual will have to re-apply and complete the certification process. Revised 6/2015

2 Oklahoma 4-H Volunteer Core Competencies Competency Behavioral Indicators Oklahoma 4-H Youth Development Communication Skills Effectively expresses ideas and facts concisely and in an organized manner through oral and written communication. Works well with 4-H members, parents, volunteers and extension staff. Practices active listening skills. Shares information in a timely and diplomatic way. Uses a variety of positive methods to promote 4-H and Cooperative Extension. Interpersonal skills Considers and responds appropriately to the needs, feelings and capabilities of others. Demonstrates good citizenship and treats others with respect and fairness. Exhibits patience in appropriate situations. Flexibility Is open-minded to new ideas, change, and new information. Adapts behavior and methods in response to new information, changing conditions and priorities, demands, unexpected obstacles, or situations. Demonstrates ability to compromise. Demonstrates flexibility due to change in conditions, priorities, demands or situations. Adapts leadership style to variety of situations. Adapts educational strategy for situation and audience. Encourages the development and use of imagination in the decision-making process. Decisiveness Exercises good judgment based on situation and surroundings. Makes sound, well-informed decisions. Perceives the impact of decisions. Commits to action to accomplish organizational goals. Initiative Motivated, self-starter. Committed to positive ethics in youth development trustworthiness, respect, responsibility, fairness, caring, and citizenship. Follows through with projects and commitment. Works to develop an area of expertise. Recognizes own strengths and weaknesses and committed to personal improvement. Demonstrates belief in own abilities and ideas. Organizational Skills Effectively manages time, resources and people. Is prompt. Successfully manages multiple tasks. Uses conceptual and creative thinking in decision-making. Uses a proactive approach to problem solving. Uses a variety of educational tools (newsletters, presentations, tours, judging, news releases, displays, etc.). Evaluates strength, benefits and quality of educational programs. Service Orientation Effectively manages, develops and delivers educational programming. Is concerned with public perception and satisfaction. Is honest, trustworthy, fair, and dependable. Appearance and behavior is appropriate and professional. Works effectively with diverse audiences. Teamwork Offers assistance and is supportive of others. Gains satisfaction from group achievement. Demonstrates ability to work with diverse personalities. Maintains credibility with others. Coaches, mentors, and challenges peers and youth. Inspires, motivates and guides others toward goal(s) accomplishment. Actively involved and supportive of small group, club and county efforts. Institutional Systems Understands and appropriately applies procedures, requirements, regulations and policies as related to 4-H and Oklahoma Cooperative Extension. Supports and works effectively within the organizational and management systems of the local, county, and state 4-H programs. Supports the non-discrimination statement of the Oklahoma Cooperative Extension Service. Demonstrates commitment to positive youth development and education. Effective 6/22/2015 Page 2 of 10

3 Oklahoma 4-H Youth Development Please complete the entire form. FAMILY INFORMATION Last Name: Mailing Address: City:, OKLAHOMA Zip Code: Primary Phone: Correspondence Preference: Mail Are you in a Military 4-H Club? Yes No MEMBER INFORMATION Member First Name: Middle Name: Last Name: Preferred Name (if different than first name): Job Title Birth Date (MM/DD/YYYY): Gender: Female Male Correspondence Preference: Mail Cell Phone: Do you wish to receive notices via text message? Yes No If yes, Cell Phone Provider: Work Phone: Work Phone Extension: *Years in 4-H: VOLUNTEER I am applying to be a certified 4-H Volunteer. Yes No DEMOGRAPHIC INFORMATION Are you of Hispanic or Latino ethnicity? Yes No Race (Check all that apply): White Black/African American American Indian/Alaskan Native Native Hawaiian/Pacific Islander Asian Balance (other combinations) Prefer not to state Residence: Farm Town under 10,000/Rural Non-Farm Town/City 10,000-50,000 and its suburbs Suburb of city more than 50,000 Central city more than 50,000 MILITARY SERVICE OF FAMILY Family Member Military Service: No Parent Serving Sibling Serving Son/Daughter Serving Me and/or Spouse currently Serving Branch of Service: Branch Component: Active National Guard Reserves NATIVE AMERICAN INFORMATION Tribe Name: Not a member of a tribe T-SHIRT SIZE Youth Size OR Adult Size Effective 6/22/2015 Page 3 of 10

4 4-H CLUB Oklahoma 4-H Youth Development Name of Primary Club: Other 4-H Clubs you are associated with The Cooperative Extension Service Office is responsible for providing you a position description for each Volunteer Type in which you serve the Oklahoma 4-H Youth Development Program. Volunteer Type: Cloverbud Leader Club Leader General Volunteer/Leader Project Leader Select Projects from list below in which you are interested in serving as a Project Leader: A to D Aerospace & Rocketry ATV Automotive Beef Bicycle Childcare, Child Development Citizenship Government, Service Learning and Community Service Communication Arts - Graphics, Writing/Poetry, Print, Story Telling, Filmmaking, Photography Companion Animals Dog, Cat, Pocket Pets, Guinea Pigs, Birds, Fish, Reptiles, Other Consumer Education Dairy Design and Construction - Apparel and Sewing Design and Construction - Hobbies and Textiles: Quilting, Knitting, Embroidery, Crochet, Fabric art, Crafts and Sewing Design and Construction - Interiors, Personal Living Space and Sewing E to H Electricity & Electronics Energy - wind, electric, hydro, solar, gas, oil, coal, etc. Entomology and Bees Entrepreneurship Environmental Stewardship - Recycling, Composting, Water Conservation, etc. Expressive Arts: Visual Arts, Drawing, Painting, Sculpture, Crafts, Leather, etc. Farm Machinery Flower Gardening & House Plants Foods and Nutrition - Breads, Cooking/ Preparation, Preservation, Presentation, etc. Gardens - Fruits/Vegetables Goats meat, milk and hair Health & Fitness Hobbies and Collectables Horse, Donkey, Mule I to P Industrial Arts - woodworking, welding, construction, etc. International/Cultural Education - exchange programs, service abroad, education abroad Leadership Llama Meats Meteorology - Weather and Climate Natural Resources - Wildlife and Fisheries, Game Birds, Forestry, Geology, Range Ornamental Horticulture & Landscaping Outdoor Education - Camping, Recreation, High Adventure, Hiking, etc. Performing Arts: Dance, Drama, Theater, Clowning, Mime, Music, etc. Personal Development Photography Plant and Soil Sciences Postmark Poultry Public Speaking R to V Rabbits Recreation and Leisure Education Robotics Safety - Home, Farm, School, Personal Science Engineering and Technology - TechXcite, GPS, UAV, Computer Science, etc Sheep Shooting Sports -.22 Pistol Shooting Sports -.22 Rifle Shooting Sports - Air Pistol Shooting Sports - Air Rifle Shooting Sports - Archery Shooting Sports Hunting and Wildlife Shooting Sports - Muzzle Loader Shooting Sports Shotgun Shooting Sports Western Heritage Small Engines Sportfishing Swine Tractor and Machinery Safety Vet Science Effective 6/22/2015 Page 4 of 10

5 * Adult Authorizations All boxes must be answered Assumption of Risk and Release of Claims: Being fully familiar with the activities of the 4-H Programs, I further acknowledge that the performance of the volunteer work and participation in the activities involved in said work and/or events are not without some inherent dangers, hazards and risks of injury, including bodily injury and death. As such, I do hereby agree to assume all of the risks and responsibilities surrounding my volunteer activities and I do for myself, my heirs, and personal representatives hereby agree to release, waive, forever discharge and covenant not to sue the Oklahoma 4-H Program, the Oklahoma Cooperative Extension Service, Oklahoma State University, the governing Board of Regents of the universities, and all officers, agents, and/or employees thereof from and against any and all claims, demands, and actions or causes of action on account of damage to personal property or personal injury or death which may result from the performance of my volunteer activities and/or my participation in the activities or events thereof. I further understand that any accident insurance policy, if any, carried by the 4-H Program or 4-H event organizers through American Income Life Insurance Co. or other insurance company will provide minimum coverage only, and I will be responsible for the costs associated with my care and treatment related to any such accident, injury or loss. Adult Behavioral Guidelines I have read the Behavioral Guidelines on page 4 and understand that breaching the behavioral guidelines can be grounds for severing my relationship as a volunteer with the Oklahoma 4-H Youth Development Program. Medical Release - I understand it is my responsibility to complete the EMERGENCY INFORMATION AND AUTHORIZATION FOR MEDICAL CARE form to participate in some events/programs/activities. A complete copy of the Adult medical Form 4 can be downloaded at Oklahoma State University s position on the care and treatment of persons participating in the 4-H Youth Development Program, as stated on Health Form 4 I understand that a health problem or a medical emergency may develop that necessitates the administration of medical care, hospitalization or surgery. I further recognize and understand that there may be situations where I require immediate medical or hospital care, and it may not be possible to give my consent. In such situations, I give permission to Oklahoma State University and its representative(s) or agent(s) to provide this medical history form to health care personnel. I further authorize a physician, surgeon, other health care provider, or dentist to exercise his/her professional judgment and assess the risks and choose the necessary treatment from any available alternatives and to render such care and perform such treatment as he/she in his/her professional judgment determines to be necessary for my health and safety, and I authorize any hospital, clinic, or other health care provider to provide reasonable and necessary medical treatment or supplies. Nonextension Employee Agree Agree Extension Employees Form 6 REQUIRED I understand the position of OSU and 4-H Youth Development in my care and treatment. Check one Medical Form(s) will be completed as needed Medical form to be filled out and can be uploaded and stored electronically to be used from Sept 1-Aug 31 each year Medical form to be filled out and kept in a sealed envelope in the Extension Office. The form is only valid Sept 1- Aug 31 each year. Publicity Release - I authorize the Oklahoma 4-H Program, Oklahoma Cooperative Extension Service and/or Oklahoma State University to photograph, film, audio/video record and/or televise my image and voice, and, to reuse, publish, perform, reproduce, adapt, distribute, or transmit the same, in whole, in part, or in composite, through any medium, and for any purpose whatsoever, without restriction, and to use my name in connection therewith. Consent Given Decline do not use my name and/or photo for any publicity. Effective 6/22/2015 Page 5 of 10

6 Statement of Understanding A Volunteer is a person who, of his/her own volition, gives his/her services without any express or implied promise or expectation of remuneration or compensation. I acknowledge that my services to the Oklahoma 4-H Program, Oklahoma Cooperative Extension Service, Oklahoma State University and/or 4-H event organizers are entirely voluntary, and I do not expect, nor am I entitled to, nor will the Program, Extension Service, Universities and/or event organizers pay or be responsible for, any wages, other compensation or remuneration, or any other benefit, including, but not limited to, workers' compensation insurance coverage. I acknowledge that even though I am a Volunteer, it is my responsibility to conduct myself in a manner that will properly represent the Oklahoma 4-H Program. I further acknowledge breach in the Volunteer Behavioral Guidelines or any other established rules/guidelines for sanctioned 4-H activities is grounds for immediate dismissal as a 4-H Volunteer, and that as a Volunteer, I am not guaranteed any future employment with the Program, Extension Service, University and/or event organizers, nor am I guaranteed any future Volunteer position. I have read and understand the Statement of Understanding I understand my role/duties as a 4-H volunteer as provided by the extension educator. Survey and Evaluation Release I am willing to participate in and/or complete surveys and evaluations that will be used to determine program effectiveness or to promote the program. I understand that participation in surveys and evaluations is voluntary and that I may choose not participate without any impact on my ability to participate in the program. I understand as a volunteer I will be asked for my verbal assent before completing a survey or evaluation. AS A 4-H VOLUNTEER I AGREE : To provide a positive educational environment that will enable youth to grow, learn and develop friendships. To promote responsibility, personal growth and goal setting in 4-H projects by each member. To inform 4-H members and families of Extension program opportunities. To serve at the pleasure of the Oklahoma Cooperative Extension Service/OSU. That a breach in the Volunteer Behavioral Guidelines or any other established rules/guidelines for sanctioned 4-H activities is grounds for immediate dismissal as a 4-H Volunteer. To annually complete a minimum of four (4) continuing education/volunteer trainings, as well as required Working with Minors training and Title 7/9 training or my status can become probationary, inactive or revoked. The number of required trainings is subject to review and change by the OCES 4-H Youth Development Program. To participate in Parent-Volunteer Association/county leader s council meetings and committee work. To actively seek volunteers/youth from a variety of racial, ethnic, religious and socio-economic groups. To recruit and involve other volunteers in programming efforts. To maintain sound working relationships with county Extension Educator and fellow volunteers. To be supportive of Extension programs. To inform county Extension Educator of needs and changes necessary for the continued growth of the 4-H program. Consent Given Agree Decline participation My signature indicates that: I have read this entire enrollment package and agree to provide leadership and assistance to 4-H members, volunteers and the 4-H Youth Development effort in Oklahoma. I have received a position description for my role(s) in my club and county. 4-H volunteers Signature Date Effective 6/22/2015 Page 6 of 10

7 Oklahoma 4-H Volunteer Management System BEHAVIORAL GUIDELINES For Extension Educators and Volunteers Working with Oklahoma 4-H Youth Development Programs Oklahoma families and other youth service programs trust in the Oklahoma Cooperative Extension Service to provide educational programs in a safe environment for participating youth. Adults who assume educator and volunteer roles within Extension have the opportunity for a rewarding experience. The opportunity to work with youth is a privileged position of trust that should be held only by those who are willing to demonstrate behaviors that fulfill this trust. The following behavioral expectations have been established for persons serving in educator and volunteer roles within Oklahoma Cooperative Extension Service programs. 1. Work cooperatively with youth, families, volunteers, Oklahoma Cooperative Extension Service faculty and staff, and others in a courteous, respectful manner demonstrating behaviors appropriate for a positive role model for youth. 2. Represent the Cooperative Extension Service and the 4-H program with pride and dignity, behave appropriately, exhibit good sportsmanship, and demonstrate reasonable conflict management skills. 3. Respect, adhere to, and enforce the rules, policies, and guidelines established by the Oklahoma Cooperative Extension Service and any other established rules or guidelines for sanctioned 4-H activities, this includes all state laws related to child abuse and substance abuse. 4. Recognize that verbal, mental or physical abuse, hazing or committing criminal acts or being aware of the same are grounds for termination as a volunteer or 4-H educator. 5. Comply with equal opportunity and anti-discrimination laws. Make all reasonable efforts to assure that 4-H youth programs are accessible to youth without regard to race, color, national origin, genetic information, sex, age, sexual orientation, gender identity, religion, disability, or status as a veteran. 6. Treat animals humanely and encourage 4-H youth and adults to provide appropriate and ethical animal care. 7. Under no circumstances, allow or consume alcohol or illegal drugs at 4-H events or activities. Understand that the use of or being under the influence of alcohol or illegal drugs while in the presence of 4-H members and/or at 4-H programs or activities are grounds for termination as a volunteer or 4-H educator. 8. The use of tobacco or vapor products in the presence of 4-H members and/or during 4-H events and activities is strongly discouraged, as the use of these products by minors is illegal. 9. Operate machinery, vehicles, and other equipment in a safe and responsible manner when working with youth and adults participating in 4-H programs. 10. Accept responsibility to promote, conduct, and support 4-H programs in order to develop an effective county, district, state, and national 4-H program. Breaching the behavioral guidelines can be grounds for severing my relationship as a volunteer with the Oklahoma 4-H Youth Development Program. Oklahoma State University, in compliance with Title VI and VII of the Civil Rights Act of 1964, Executive Order as amended, and Title IX of the Education Amendments of 1972 (Higher Education Act), the Americans with Disabilities Act of 1990, and other federal and state laws and regulations, does not discriminate on the basis of race, color, national origin, genetic information, sex, age, sexual orientation, gender identity, religion, disability, or status as a veteran, in any of its policies, practices or procedures. This provision includes, but is not limited to admissions, employment, financial aid, and educational services. The Director of Equal Opportunity, 408 Whitehurst, OSU, Stillwater, OK ; Phone ; eeo@okstate.edu has been designated to handle inquiries regarding nondiscrimination policies: Director of Equal Opportunity. Any person (student, faculty, or staff) who believes that discriminatory practices have been engaged in based on gender may discuss his or her concerns and file informal or formal complaints of possible violations of Title IX with OSU s Title IX Coordinator Effective 6/22/2015 Page 7 of 10

8 History of Applicant The following information is required and used by the Volunteer Advisory Committee (VAC) to interview and/or screen volunteers applying to serve at the pleasure of the Oklahoma Cooperative Extension Service. History of Residence(s) Number of years at address listed on page 1? List Residential Address(s) over the past 5 years Unlawful History Can you provide your own transportation? Yes No Has your driver s license ever been suspended or revoked? (If yes, explain.) Do you use illegal drugs or misuse legal/controlled substances. (If yes, explain) Yes Yes No No Have you ever been convicted of a crime; a criminal traffic offense, other than a minor traffic offense? (If yes, explain.) Yes No Have you ever been convicted of child neglect, abuse or assault? (If yes, explain.) Yes No Do you have a record of miss handling finances/money/books? (If yes, explain.) Yes No Other than the above, is there any fact or circumstance involving you or your background that would call into question your being entrusted with the supervision, guidance, and care of young people? (If yes, explain.) Yes No Current Employment Occupation Employers Name Employers Address Supervisor and Number of Years with current employer. Employer s Phone Effective 6/22/2015 Page 8 of 10

9 4-H Background (Please include membership information, 4-H volunteer experiences, etc.) Position County State Year(s) Experience working with youth and adults in other organizations Current memberships (community, business, labor, Educator organizations, etc.) REFERENCES: Please list three references (not related) who are familiar with your character as it relates to working with youth and adults. References will be checked when necessary. Reference 1 Relationship Legal Name Home/Cell Phone Work Phone address Full Mailing Address Reference 2 Legal Name Relationship Home/Cell Phone Work Phone address Full Mailing Address Reference 3 Legal Name Relationship Home/Cell Phone Work Phone address Full Mailing Address *Attach additional documents as necessary for explanation or support of your application. Effective 6/22/2015 Page 9 of 10

10 I understand that: a. The information that I have provided is true and may be verified by contacting persons or organizations named in this application, or by contacting any persons or organizations that may have information concerning me. I hereby release and agree to hold harmless from liability any person or organization that provides information about me. I also agree to hold harmless the chartered organization, Parent-Volunteer Association, the 4-H program, Cooperative Extension Service, Oklahoma State University and Langston University, and the officers, employees, and volunteers thereof. Date Date Applicant s Signature Parent/Guardian s Signature Applicants under the age of 18 require a guardian s signature. This box is to be completed by the Extension Office and recorded in 4HOnline. The completed application is to be saved as a PDF file and uploaded to 4HOnline. Is the applicant listed on the Sexual Offender or Violent Offender Registry? National Sexual Offender Registry - Yes No Oklahoma Violent Offender Registry - Yes No Approved by Volunteer Advisory Committee: We are unaware of any information contrary to the information stated on this application or provided by references. Denied by Volunteer Advisory Committee: We do not find this individual to be a viable candidate for volunteer certification in the Oklahoma 4-H Youth Development program. Date Signature of Volunteer Advisory Committee Representative(s) Date Signature of Extension Educator Certification Requirements Completed Oklahoma 4-H Youth Development Orientation Completed Working with Minors Training Completed Title VII/IX Training Completed Certification Completed Volunteer notified by mail/ Date Date Date Date Sample notification letters are posted at Letter 1 Application Received Letter 2 Application Approved Letter 3 Application Denied Letter 4 Completed Certification Process Letter 5 Need to Complete Certification Process Certificate Effective 6/22/2015 Page 10 of 10

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