Maine 4-H Youth Development Volunteer Application

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

County*

Select the County or Program in which you wish to volunteer*

Phone*

Cell Phone

Email*

Enter Email Confirm Email

Were you in 4-H?*

Yes
No

If you were in 4-H, where?

Have you ever been a 4-H leader?*

Yes
No

If yes, how many years?

Where did you volunteer?

City	County	State

Which volunteer role are you interested in?*

Please explain why you are interested in a 4-H volunteer position.*

Do you prefer to work directly with*

Youth
Adults
Both

If you prefer to work with youth, what grade level(s) do you prefer?*

Select All
Pre-school
Primary Grades: 1, 2
Junior Grades: 3, 4, 5
Intermediate Grades: 6, 7, 8
Senior Grades: 9, 10, 11, 12

Previous work or volunteer experience (List current or most recent experience first.)*

Employer or Organization	Position Title or Volunteer Role	Year

Skills, Training, Education*

Hobbies and interests*

How did you hear about the 4-H volunteer program?*

Reference: List a person not related to you who has definite knowledge of your qualifications. Include complete address.*

Name	Day Phone Number	Address	Email

Reference: List a person not related to you who has definite knowledge of your qualifications. Include complete address.*

Name	Day Phone Number	Address	Email

May we contact other references suggested to us in the course of contacting the references listed above?*

Have you ever been convicted of any crime other than a minor traffic violation? If yes, please describe.*

How would you prefer to receive paperwork from us?*

Consent*

I agree to the following statement. I authorize contact of listed references. I understand that misrepresentation or omission of facts requested is cause for non-appointment or termination as a Cooperative Extension Volunteer and to fulfill the volunteer responsibilities to the best of my ability.

You will receive a copy of your application via email. (Check your SPAM if your email notification does not appear in your inbox.)

*** *indicates the question is required.***

If you do not see a Submit Button displayed here, please go back to the question, "County" and make sure you've selected the county where you reside from the dropdown menu. Thank you!

Name

This field is for validation purposes and should be left unchanged.

Cooperative Extension: 4-H

* indicates the question is required.

If you do not see a Submit Button displayed here, please go back to the question, "County" and make sure you've selected the county where you reside from the dropdown menu. Thank you!

*** *indicates the question is required.***