Cooperative Extension, Sutter-Yuba Counties
University of California
Cooperative Extension, Sutter-Yuba Counties

Application Packet Survey

Application Survey

PLEASE COMPLETE BY NOVEMBER 16, 2018

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MASTER GARDENER VOLUNTEER APPLICATION SURVEY

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10. What teaching/communication experience do you have? List types of experiences:

   

I wish to be considered for acceptance into the UCCE MGP training program offered by the University of California Cooperative Extension. I understand that if I am accepted, I will become a certified UCCE MGP volunteer when I complete 16 weeks of classes and pass a written examination by 70%. I understand, that in exchange for the training made possible by the program, I will volunteer at least 50 hours of volunteer time to the UCCE MGP within one year of certifying, attend all training classes, submit volunteer hours, follow University policies and procedures while acting as a UC Master Gardener and agree to a background and fingerprint screening prior to the beginning of the training program. I also agree to complete the forms required for appointment which include: Proof of valid driver’s license and insurance (only if driving will be part of your duties as a volunteer), the Code of Conduct, Annual Volunteer Agreement and pay an annual nominal insurance fee.

Information on this form is being requested under the authority of the Smith-Lever Act of 1914 covering Cooperative Extension activities and Article IX, Section 9 of the State of California Constitution covering the University of California. Ethnic information is requested to maintain compliance with Title VI of the civil Rights act of 1964 and sex information is requested to maintain with the Title IX of the Education Amendments of 1972. Statistical information on this  form is being collected to satisfy the U.S. Department of Agriculture Extension Service reporting requirements for Affirmative Action and the Federal Affirmative Action Program Report. Statistical information includes sex, ethnic, information and residence location. Submission of the above noted information is voluntary and if the information is not submitted by the source, the county Master Gardener staff may use his or her judgment to complete the information and satisfy Federal reporting requirements. Other personal information on this form is being collected to provide the County Extension Master Gardener staff with information to assist in program planning. This information consists of name, address, phone and email in addition to your skill set assessment.

In compliance wit the California Information Practices Act of 1977, the following information is provided: The information in this form is being requested by the University of California Cooperative Extension (UCCE) for use in the UCCE Master Gardener Program. The individual completing this form may make inquiries concerning use of the information collected and may ask to review the form as well as other non-confidential personal information maintained on record by contacting the local UCCE County Director Advisor, Program Coordinator or the statewide Director for the UC Master Gardener Program at: UC Master Gardener Program, 2801 2nd Street, Davis, CA 95618-7779. 

The University of California, Division of Agriculture and Natural Resources (UC ANR) prohibits discrimination against or harassment of any persons in any of its programs or activities on the basis of race, color, national origin, religion, sex, gender, gender expression, gender identity, pregnancy (which includes pregnancy, childbirth, and medical conditions related ot pregnancy or child birth), physical or mental disability, medical condition (cancer-related or genetic characteristic), genetic information (including family medical history), ancestry, marital status, age, sexual orientation, citizenship, status as a protected veteran or service in the uniformed services (as defined by the Uniformed Service Employment and Reemployment Rights Act of 1994 [USERRA]), as well as state military and naval service. University policy is intended to be consistent with the provisions of applicable State and Federal laws. Inquiries regarding the University's non-discrimination policies may be directed to the Affirmative Action Contact and Title IX Officer, University of California, Agriculture and Natural Resources, 2801 Second Street, Davis, CA 95618, (530) 750-1318.

Webmaster Email: mlsearcy@ucanr.edu