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Trainee Application Form - Master Gardener™ Online

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As of December 19, 2011, this application is now closed.
This application is for individuals interested in taking part in the volunteer option of the Master Gardener™ Online program (Option 2), including work with an OSU Extension Service office. If you are only interested in the online course (Option 1), this application is not required and you can register now.
Once you've applied, if you are accepted as a Master Gardener trainee for the winter 2012 offering of the Master Gardener Online course, you will receive a letter of acceptance, with a password and link for registration, no later than December 19, 2011. Please note: a letter of acceptance is required to enter the online course as a Master Gardener trainee (i.e. those pursuing a Master Gardener badge). However, you may register without a letter of acceptance if you are pursuing the Certificate of Home Horticulture ($490 registration fee and no volunteer service requirement).
Early application is encouraged for both the Master Gardener badge and the Certificate of Home Horticulture options, as space is limited. Master Gardener badge (Option 2) applications submitted by November 14, 2011 will be given first priority.
Asterisks (*) indicate required information.
* First Name:
* Last Name:
* Address Line 1:
Address Line 2:
* City:
State:
* Zip Code:
Nation:

 		United States of America
* Phone Number:
* Email:
Cell Phone:
 
 
I want to take the online Master Gardener course of instruction AND volunteer the number of hours required by my county Extension office, en route to becoming a certified OSU Extension Master Gardener. The cost of this option is $390, and includes access the online Master Gardener course and instruction, as well as coordination and supervision of volunteer activities out of my County Extension office.
Selected winter 2012 option:
 
 
 		OSU Certified Master Gardener (Option 2, volunteer hours, $390)
* Please select the county Extension office that you would be working with to complete your volunteer service:
 
Please briefly answer the questions that follow.
 
* How did you learn of the Master Gardener™ Program?
* How many years of gardening experience do you have?
* Please list any specialized garden-related training you have received.
* What interests you and what do you expect to gain from the Master Gardener™ program?
* Please list areas of specialization or hobbies (e.g. vegetables, greenhouses, roses, etc.)
* In what ways could you best contribute to the Master Gardener™ program? For example: teaching, 4-H and youth projects, senior projects, horticultural demonstrations, web page construction and maintenance, etc.
* Please list volunteer activities in which you have participated within the last five years.
* Please list one personal reference, include address and phone number.
* Please list general days and times that you know you will not be available for volunteer service (vacation, job, other regular commitments).
 
The following information is required on federal reports and affects funding. Ethnic data is required for institutional compliance with the Civil Rights Act of 1964. Please choose an appropriate option from each drop-down list.
 
* Ethnicity:
* Gender:
 
 
I certify that all the information given in this application is true, accurate and complete, to the best of my knowledge.
 
* Signature (type full name):
Date:
 
 		02/12/12
 
 
Oregon State University Extension Service offers educational programs, activities, and materials—without regard to race, color, religion, sex, sexual orientation, national origin, age, marital status, disability, and disabled veteran or Vietnam-era veteran status—as required by Title VI of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973. Oregon State University Extension Service is an Equal Opportunity Employer.



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