Master Gardener Volunteer Registration Form
Master Gardener Volunteer Program, Cornell Cooperative Extension Allegany County

This is the official registration form for our Master Gardener Volunteer training 2023. Please, fill out this form ONLY if you want to become a Master Gardener Volunteer and be part of this amazing community. This is a volunteer program, if you're interested only in gardening/agriculture courses, please visit the website of Cornell college of agriculture and life sciences CALS. 
Note: All the information that you provide in this form is confidential and never exposed to the public, it's used only for placement and training purposes. 
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PART I - All applicants must complete this part.
Full Name (First, middle, and Last name)
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Address
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Email Address
Have you passed your 18th birthday?
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Phone number *
Driver's License # (Note: Your motor vehicle driving record will be checked if the volunteer position you seek involves transportation of others in your personal vehicle or use of Cornell Cooperative Extension vehicles.) *
Volunteer History: If you have ever been involuntarily terminated from a volunteer position please tell us when and why?  *

Records: A criminal record will be evaluated only in relation to the volunteer position for which you have applied; seriousness and nature of offense, time elapsed and rehabilitation will be considered. Have you ever been convicted of a criminal offense? if Yes, please give date, nature of the offense and disposition.

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If the volunteer position you are seeking involves work with children, the elderly or individuals with disabilities, have you ever been held accountable for abuse, maltreatment or neglect? ________   If so, please explain.

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References: List two persons not related to you who have definite knowledge of your qualifications and can attest to your character.  Complete addresses are needed.  

Reference 1: (name, address, phone and/or email, how do you know this person?)

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Reference 2: (name, address, phone and/or email, how do you know this person?)
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*I authorize contact of listed references and verification of delinquency history.  I release all parties contacted from all liability arising from the provision of requested information.  I understand that misrepresentation or omission of facts requested is cause for non-appointment or termination as a Cornell Cooperative Extension Volunteer.

Clear selection
if YES, provide a digital signature typing your Full name and date (example: John Grace McKind - 09/01/2023) *
PART II - APPLICANT PROFILE: The information requested is used solely for placement and training purposes. 
A.  What interests do you wish to pursue or what do you hope to accomplish by serving as a CCE volunteer?  *

B. List volunteer, paid or educational experiences that relate to the volunteer position you seek (gardening, environment, sciences, education, etc.)

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C. List any skills, hobbies, interests or languages spoken that might be helpful in your volunteer work. 
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D. What time commitment do you initially desire?
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How much time can you commit on a regular basis?  State hours per week or month: 
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When are you available for training-volunteering?  State days of week , times of day and months of year:
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E. If the position you desire involves teaching or working with groups check the audience(s) you prefer. (mark one or more options)
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Required

Please list your interests in working with special needs children, children or adults with disabilities, limited-resource families, or specific ethnic or cultural groups

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F. Do you have an independent and reliable means of transportation?
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G. Would you prefer a training: (check one or more options) *
Required
Best time to contact:
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Cornell Cooperative Extension actively affirms equality of program and employment opportunities regardless of race, color, national origin, religion, disability, age, gender, sexual orientation or marital status.

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