application form

Extension Master Gardener Application

Application form to take training for $160 with 50 hr. volunteer time payback requirement.

Please fill out this application completely. Please type or print. Send completed form and $50 refundable deposit to your home county. (Make checks payable to "Horticulture Extension Operating") The remaining fee of $110 will be due on the first day of training.

1) Name: ____________________________________

Address: __________________________________

City: ________________________

Zip Code: _______________ County ____________________

Telephone: ____________________ Email Address __________________________________________

2) Please indicate the training site you will be attending._________________________________________

3) Which county(s) do you want to do your volunteer work in? _____________________

4) Years of gardening experience in this area: ________________________

5) Where did you garden before living here? ______________________________

6) Do you have any formal training in Horticulture or Agriculture? _________________________

Please explain ______________________________________________________________________________________

______________________________________________________________________________________

7) Please list areas of specialization or hobbies ( i.e. roses, vegetables, ornamentals, perennials, houseplants, greenhouse etc.) ______________________________________________________________________________________

______________________________________________________________________________________

8) How did you learn about the Master Gardener Program?______________________________________________________________________________

_____________________________________________________________________________________

9) Please describe any volunteer work you may have done in the past.

_____________________________________________________________________________________

10) Why do you wish to become a Master Gardener? (Attach separate page if necessary)

_____________________________________________________________________________________

11) Suggest how you might use your training to help people, if you are selected for the Master Gardener Program.______________________________________________________________________________

_____________________________________________________________________________________

12) Please describe any communication skills you may have (i.e. enjoy writing, giving speeches, small group talks, telephone, typing, word processing etc.

_____________________________________________________________________________________

13) Are you a full time employee? _______ (YES or NO). If you are, please explain how you feel you will be able to fulfill the payback time commitment of 50 hours.

_____________________________________________________________________________________

14) If selected for the Master Gardener Program, I understand that I am obligated to attend all classes and devote a minimum of 50 hours of apprentice service back to the program, county or state over the next two years upon completion of the training. If unforseen circumstances prevent me from completing my 50 hours of apprentice service, I will make other arrangements with the county Extension Agent to fulfill that commitment.

Signature __________________________ Date ________________

Return this completed application to your local County Extension office, as soon as possible, as enrollment is limited. Please contact the local county office for exact deadlines. Note: All applications are subject to review by the County Extension Educator and/or another local Master Gardener committee.