4-H STEM Ambassador Enrollment, Non-discrimination Statement, Standards of Behavior, and Media Release Form

Optional Demographic Data

Please provide us with this optional data so that we may report to our federal partners.

Agreement to the following non-discrimination and standards of behavior statements are required of all active UMaine Cooperative Extension Volunteers. Please read them carefully before indicating yes or no.

Non-discrimination statement (mandatory):

I confirm that we do not discriminate on the grounds of race, color, religion, sex, sexual orientation, including transgender status and gender expression, national origin, citizenship status, age, disability, genetic information or veteran's status in employment, education, and all other programs and activities. To ensure participation in Extension programs, reasonable accommodations will be provided. I understand that I will work with the appropriate Extension staff member to provide accommodations.

Standards of behavior statement (mandatory) :

As a trained UMaine Extension volunteer, while I am representing the University of Maine Cooperative Extension, I am required to:

1. seek diverse audiences and provide equal access to all Extension programs including working with staff to provide accommodations.

2. comply with state, federal and University equal opportunity and non-discrimination laws and guidelines; I will not discriminate on the grounds of race, color, religion, sex, sexual orientation, including transgender status or gender expression, national origin, citizenship status, age, disability, genetic information or veteran’s status.

3. not violate the sexual harassment policy of the University of Maine System.

4. report all incidents of sexual misconduct and report all known or suspected child abuse/neglect. (Note: a refresher training via video is available at http://extension.umaine.edu/volunteer/orientation/required-training/

5. treat all program participants, volunteers, Extension staff, others and myself with courtesy and respect.

6. work cooperatively with other volunteers, families and Extension staff/colleagues.

7. not share confidential information except as authorized or required by policy or law.

8. not use alcohol, tobacco or illegal drugs at any UMaine Extension event.

9. not commit an illegal or abusive act; immediately report potentially illegal acts to both Extension staff and the authorities.

10. participate in required volunteer training programs and follow the stated policies and procedures.

11. treat program areas, lodging areas and transportation vehicles with respect.

12. handle any money, animals, machinery, equipment, or other UMaine Extension property that has been entrusted to me in a safe and responsible manner.

13. report all unsafe conditions and accidents to Extension staff/colleagues as soon as possible.

14. notify my county Extension staff/colleagues if I am unable to complete an assignment, uncomfortable with an assignment, or if I need to resign.

15. not use my status as an Extension volunteer for personal or business financial gain.

Requirements and Standards of Behavior Agreement

I have read and understand the University of Maine Cooperative Extension Volunteer Requirements and Behavior Standards. I understand and agree that my actions and decisions affect me as well as others. Any action on my part that contradicts any portion of these standards may result in the loss of privileges as a volunteer or could be grounds for suspension and/or termination of my status with the UMaine Extension Program as a volunteer. I will conduct myself in accordance with the intent of the Requirements and Standards of Behavior. I will accept the appropriate and logical consequences of any actions if I fail to do so.

Photo release statement

I hereby grant and authorize the University of Maine System, acting through the University of Maine, (hereinafter UMS) its employees and agents to make use of, license or assign the use of, my image, appearance, likeness, voice and/or photograph, and other reproductions of any of these, in still photographs, videotapes, publications, audio, sound recordings, websites, electronic and other media and/or motion pictures, (hereinafter all of which are included in the term "Material") and to do so with or without mention of my name.

I understand and agree that I am to receive no compensation of any kind, monetary or otherwise, on account of or arising from the production, publication, recording, rebroadcasting, or other use of such Material.

UMS shall have complete ownership of the Material produced or published and shall have the exclusive right and license to make such use of that Material as it wishes, including, but not limited to the right of performance, display, reproduction and distribution in all media, and the right to create, perform, display and distribute derivative works of the Material.

I agree to indemnify and hold UMS, the University, its employees and agents, harmless from and against any and all claims, damages, lawsuits, judgments, and expenses, including reasonable attorneys' fees, that UMS may become liable to pay or defend arising out of or caused by any matter or material furnished or spoken by me in connection with my appearance.

I hereby release UMS, its employees and agents from all expenses, claims and liabilities incurred by me arising out of or in connection with my appearance and/or the use of the Material, except to the extent that those expenses, claims or liabilities are the direct result of the negligent acts or omissions of UMS, the University, its employees or agents.

This agreement shall be governed and construed according to the laws of the State of Maine.

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