Washington County Extension Association Application - Cooperative Extension in Washington County - University of Maine Cooperative Extension

Please complete this application if you are interested in joining the Washington County Extension Association.

Name

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Work Phone

Email

Employment

Professional Skills/Training

Volunteer Experience (years, organizations, positions)

Additional civic and fraternal activities

Specific awards, citations

Additional Information

Non-discrimination statement (mandatory):

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.

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.

Non-discrimination Statement:*

Yes, I agree to this statement.
No, I do not agree to this statement.

Type your name here to sign electronically:*