Dear Potential Ohio 4-H Volunteer,

Transcription

1 Ohi State University Extensin Highland Cunty Cllege f Fd, Agriculture and Envirnmental Sciences 119 Gvernr Fraker Place Suite 202 Hillsbr, Ohi Phne Fax Dear Ptential Ohi 4-H Vlunteer, highland.su.edu Let me take this pprtunity t thank yu fr expressing an interest in becming an Ohi State University Extensin vlunteer. Each year, thusands cntribute their time, energies, and talents that enable Ohi 4-H t reach nearly 300,000 yuth, helping Ohi State University Extensin t engage peple in educatinal prgrams that meet their immediate needs. All individuals wh are interested in vlunteering with Ohi State University Extensin and wrking with a member f a vulnerable ppulatin (minrs, elderly ver age 65, r individuals with disabilities) must cmplete a selectin prcess under the directin f an Extensin prfessinal. T mre efficiently and effectively supprt ur service recipients, Ohi State University Extensin has a plicy cncerning the selectin f individuals wh desire t vlunteer fr the rganizatin in a lng-term and/r higher risk psitin. While the actual rder f implementatin may vary frm cunty t cunty, all ptential vlunteers will: (1) receive a psitin descriptin; (2) cmplete an applicatin and return t Extensin ffice; (3) have references cllected by Extensin prfessinals; (4) cmplete an interview; (5) submit t a criminal histry fingerprint recrd check; (6) agree t and sign the vlunteer standards f behavir frm; and (7) participate in an rientatin/training prgram. Frms need t be submitted t the Extensin Office befre March 15, Please knw that all infrmatin related t the selectin prcess may be updated peridically and will be kept in a secured file cabinet. This infrmatin will be kept n file fr a minimum f three years fllwing the receipt f yur materials r the cmpletin f yur invlvement as an Ohi State University Extensin vlunteer (whichever is lngest). The release f infrmatin will fllw The Ohi State University and Ohi State University Extensin perating prcedures and will be in accrdance with Ohi law. Wrking with individuals in yur cmmunity can bring yu immense satisfactin as yu help them grw, learn, develp, and succeed. Additinally, vlunteering prvides yu an pprtunity t gain new skills, help thers, and meet new friends. We hpe that yu recgnize the tremendus benefits f vlunteering and will jin us in helping ensure that everyne invlved has a psitive, educatinal experience. We appreciate yur cperatin and lk frward t ptentially wrking with yu. Sincerely yurs, Kathy Bruynis Extensin Educatr 4-H Yuth Develpment CFAES prvides research and related educatinal prgrams t clientele n a nndiscriminatry basis. Fr mre infrmatin:

2 Ohi State University Extensin Vlunteer Selectin Plicy & Prcedures Effective: May 1, 2007 Plicy Adults wh desire t vlunteer their time, energy and talents t Ohi State University Extensin with the ptential t serve members f a vulnerable ppulatin (minrs, elderly, and/r disabled) must cmplete a vlunteer selectin prcess. Lng-Term r High Respnsibility Vlunteer Assignment Adults serving members f a vulnerable ppulatin (minrs, elderly, and/r disabled) in an unsupervised capacity with ptential fr nging/sustained cntact with clientele and/r includes pprtunities fr financial, vernight, and transprtatin respnsibilities will: 1. Receive, at the time f applicatin r change f psitin, a written vlunteer psitin descriptin utlining the respnsibilities. 2. Read, agree t, and sign the O.S.U. Extensin Vlunteer Standards f Behavir Frm. 3. Cmplete a vlunteer applicatin, in its entirety, and submit t the apprpriate O.S.U. Extensin ffice. 4. At minimum, have tw references returned that are nn-relatives, either in writing, ver the telephne, r face-t-face. 5. Cmplete an interview with the apprpriate O.S.U. Extensin representative. 6. Submit t a criminal histry fingerprint backgrund check. 7. Participate in a new vlunteer rientatin/training prgram. Shrt-Term Vlunteer Assignment Adults serving a shrt-term assignment fr a cnsecutive series f days, r several nncnsecutive days fr a perid f ne (1) week r less in which they will be under the direct supervisin f a paid staff member (r apprved vlunteer key leader), nt having the ptential fr financial, vernight, and transprtatin respnsibilities and n sustained/n-ging cntact with clientele will cmplete the fllwing selectin prcedures: 1. Receive a vlunteer rle descriptin; 2. Cmplete and submit vlunteer infrmatin frm; 3. Read, agree t, and sign the O.S.U. Extensin Vlunteer Standards f Behavir Frm; 4. Receive rle/respnsibility rientatin; and 5. Cmplete an Ohi Electrnic Sex Offender Registratin and Ntificatin (esrn) and Natinal Sex Offender Public Registry web check (nt fingerprint) based upn name, cunty, city, state, zip cde, and schl. Ohi Electrnic Sex Offender Registratin Natinal Sex Offender Public Registry Partnerships & Exceptins When entering int partnerships/cllabratins, OSU Extensin prfessinals shall wrk cperatively with thse entities t establish vlunteer selectin prcedures that meet minimum requirements f all rganizatins. In partnerships where vlunteers are representing O.S.U. Extensin prgrams, the vlunteers must meet minimum OSU Extensin selectin requirements. In limited situatins, Extensin prfessinals may need t implement alternative selectin strategies that are nt identified in OSU Extensin plicy. In thse cases, Extensin prfessinals shall wrk with the Assciate Directr, Operatins and the apprpriate prgram area representative. The fllwing are nt required t cmplete a selectin prcess: ne-time guest speakers; ne-time grup facilitatrs; judges fr pre-fair judging; cunty and state fair judges; field day hst; parents (prviding they are nt prviding leadership t children ther than their wn); and ther similar psitins. Apprved by OSU Extensin Administrative Cabinet: Octber 12, 2006

3 OHIO STATE UNIVERSITY EXTENSION I. GENERAL INFORMATION Ohi 4-H Vlunteer Applicatin Full Name: Date f Birth (MM/DD/YY): Street Address: City/State/Zip: Length f time at this address (years): Phne: Hme: Best Time t Call: Cell: Schl District: Wrk: Best Time t Call: Best Time t Call: Are Yu a 4-H Alumni: Yes N If yes, what state and cunty: Demgraphic Infrmatin Occupatin (ptinal): Level f Educatin (ptinal): Ethnicity: Hispanic Nn-hispancic Race: White Black American Indian/Alaskan Native Hawaiian/Pacific Islander Asian Residence: Farm Twn/Rural (<10,000) Twn (10,000-50,000) Suburb (< 50,000) City (> 50,000) Military Service: N ne in my family is currently serving My Parent serves My Sibling serves My Sn/Daughter serves I/my spuse/partner serve Branch f Service: Air Frce Army Cast Guard Marines Navy Branch Cmpnent: Active Guard Reserves Health Cnsideratins/Ntes (i.e., fd allergy, diabetes, etc ): II. VOLUNTEER INTEREST Why are yu interested in vlunteering fr the Ohi State University Extensin 4-H Prgram? hi4h.rg CFAES prvides research and related educatinal prgrams t clientele n a nndiscriminatry basis. Fr mre infrmatin: g.su.edu/cfaesdiversity.

4 D yu prefer t wrk directly with yuth r adults? Yuth Adults Bth If yu prefer t wrk directly with yuth, what age level(s) d yu prefer? Ages 5-8 Ages 9-12 Ages N Preference Type f 4-H Vlunteer Psitin: 4-H Club: Organizatinal Leader Clverbud Leader Prject Leader Resurce Leader Prject Area Interests: Cmmittee Member list cmmittee: Camp (check all that apply): Residential Day Special Interest/Emphasis Prgram list prgram: After-Schl Prgram list site: Cmmunity Center/Yuth Organizatinal Partner list site: Other: If yu are applying t vlunteer with a cmmunity/prject club, will yu be requesting t start a new club r assisting with an existing club? New Exisiting If exisiting, name f club: What time cmmitment d yu initially desire t give? Previus Wrk Experience (list current r mst recent experience first): Emplyer Psitin Title Year Previus Vlunteer Experience (list current r mst recent experience first): Emplyer Psitin Title Year Ohi 4-H Vlunteer Applicatin, 2/15 Page 2

5 III. PERSONAL REFERENCES Have yu ever been cnvicted f a misdemeanr r a felny? Yes N If yes, please give date, nature, and dispsitin f ffense: Please nte: A criminal recrd will be cnsidered as it relates t specifics f the vlunteer psitin fr which yu are applying. A criminal recrd may prevent an individual frm vlunteering, depending n the nature f the ffense. References: List nn-family members wh have knwledge f yur skills, abilities, and qualificatins. Individuals shuld have wrked with yu n prjects and activities and/r have direct experience with r knwledge f yur qualificatins. Please prvide cmplete addresses, phne numbers and addresses. Name: Street Address: Relatinship: City/State/Zip: Phne: Name: Street Address: Relatinship: City/State/Zip: Phne: Name: Street Address: Relatinship: City/State/Zip: Phne: I authrize the cntact f listed references and understand that I am required t submit t a fingerprint criminal backgrund check prir t final cnsideratin f my applicatin t vlunteer. I understand that misrepresentatin r missin f required infrmatin is just cause fr nn-appintment as a vlunteer with Ohi State University Extensin. I understand that I serve at the pleasure f Ohi State University Extensin and agree t abide by the plicies f Ohi State University Extensin and the Ohi 4-H Prgram and t fulfill the vlunteer respnsibilities t the best f my ability. Permissin t use phtgraphic frm fr prmtin cntingent upn cmpleting vlunteer prcess: Ohi State University Extensin wuld like t share the psitive results f yuth and vlunteer participatin in Extensin and 4-H Yuth Develpment events. Hwever, in sme cases, vlunteers may prefer nt t permit such publicity. I GIVE I DO NOT GIVE the Ohi State University permissin t publish in print, electrnic, r vide frmats the likeness r image f myself. I release all claims against the University with respect t cpyright wnership and publicatin including any claim fr cmpensatin related t use f the materials. (If nt cmpleted, OSU Extensin will nt use publicity abut yur participatin). Applicant Signature: Date: Ohi 4-H Vlunteer Applicatin, 2/15 Page 3

6 OHIO STATE UNIVERSITY EXTENSION Ohi 4-H Vlunteer Enrllment Frm ( Prject Advisr ) 4-H Club Address Years as Vlunteer (Including this year) Name (please print) First Middle Initial Last Address Cunty f Residence Street City Zip Gender Male Female Primary Phne - - Cell Phne - - Check here t receive text alerts t yur mbile device. Mbile Service Prvider (There is n fee fr this service. Hwever, standard text message rates may apply. Please cntact yur mbile service prvider fr mre details.) Crrespndence Preference Mail T-Shirt Size Yuth Adult Occupatin (ptinal) Level f Educatin (ptinal) Ethnicity (check ne) Hispanic Nt Hispanic Race (check all that apply) White Black American Indian/Alaskan Hawaiian/Pacific Islander Asian Residence (check ne) Farm Twn (Rural) Twn Suburb City (Less than 10,000) (10,000 t 50,000) (Mre than 50,000) (Mre than 50,000) I and/r my spuse/partner and/r parent serve in the Military I have a sibling and/r dependent serving in the Military Branch f Service Air Frce Army Cast Guard Marines Navy Branch Cmpnent Active Duty Natinal Guard Reserves Health Cnsideratins/Ntes (i.e. fd allergy, diabetes, etc. ) I GIVE I DO NOT GIVE the Ohi State University permissin t publish in print, electrnic, r vide frmats the likeness r image f myself. I release all claims against the University with respect t cpyright wnership and publicatin including any claim fr cmpensatin related t use f the materials. (If this sectin is nt cmpleted, Ohi State University Extensin will nt use publicity abut yur participatin) Vlunteer Type (check ne) Organizatinal Club Leader Clverbud Leader Prject Leader Resurce Leader Prjects/tpics in which I prvide leadership I als serve as a cunty vlunteer fr (list any ther cunty clubs, cmmittees, and/r rganizatins) I am a previus 4-H member Yes N If yes, Cunty and State I have cmpleted the required backgrund check and screening prcess I have read, understand, and agree t be bund by the VOLUNTEER STANDARDS OF BEHAVIOR utlined n the back f this frm. Vlunteer Signature Date OSU EXTENSION, HIGHLAND COUNTY 119 GOVERNOR FORAKER PLACE; SUITE 202 HILLSBORO, OHIO (937)

7 OHIO STATE UNIVERSITY EXTENSION Vlunteer Psitin Descriptin 4-H Yuth Develpment Psitin Title: 4-H Club Organizatinal Vlunteer Time Required On-ging and dependent n cunty General Purpse: Serve as a liaisn between the club s membership and the 4-H Yuth Develpment prfessinal regarding verall club management and leadership. Specific Respnsibilities: Serve as the primary cmmunity link between the Cunty Extensin ffice, Cunty 4-H prfessinals and the 4-H club, maintaining cmmunicatin with all club advisrs. Secure, cmplete, and submit club rganizatin/enrllment materials t the cunty Extensin ffice. Prvide cunty Extensin ffice with all requested materials related t the 4-H club Ensure adequate supervisin at all club functins. Invlve members in develping club prgrams, including prject wrk, cmmunity service, scial events and participatin in cunty, reginal and state 4-H events. Assist fficers t learn their respnsibilities. Welcme parent/guardian interest, ideas, supprt, and attendance at club activities. Fllw all O.S.U. Extensin and 4-H Yuth Develpment plicies and prcedures. Recruit new members when the club has penings. Attend all (r mst) f the club meetings and activities. Read 4-H mailings and access infrmatin frm the 4-H web t keep membership current. Participate in vlunteer develpment pprtunities t stay current and enhance leadership skills. Infrm members/parents f 4-H guidelines and requirements. Prvide psitive and cnstructive feedback t members and parents/guardians. Qualificatins & Expectatins: Ability, interest, and willingness t: Wrk with vlunteers and 4-H prfessinals t teach and mtivate yuth while nurturing psitive self esteem, decisin making, respnsibility, and leadership. Effectively rganize, delegate, and cmmunicate (verbal and written) Wrk with minimal supervisin frm prfessinal staff. Becme familiar with and wrk within the philsphy and guidelines f Ohi State University Extensin, Ohi 4-H Prgram and the Cunty 4-H prgram. Ohi State University Extensin Agrees t: Prvide training pprtunities t assist vlunteers t meet needs f members and parents. Prvide access t educatinal materials and resurces. Have prfessinal staff available t cnsult with and listen t vlunteers. Prvide apprpriate recgnitin and awards t vlunteers. Mentr/Supervising Prfessinals: Cunty Extensin 4-H Yuth Develpment Prfessinal(s) I have read and I understand the respnsibilities which I will be expected t fulfill as a 4-H Advisr/Vlunteer. I als understand that this agreement may be terminated by either party. 4-H Vlunteer Date Extensin Educatr Date Print Name Club Name CFAES prvides research and related educatinal prgrams t clients n a nndiscriminatry basis. Fr mre infrmatin: OSU EXTENSION, HIGHLAND COUNTY 119 GOVERNOR FORAKER PLACE; SUITE 202 HILLSBORO, OHIO (937)

8 OHIO STATE UNIVERSITY EXTENSION VOLUNTEER STANDARDS OF BEHAVIOR These Standards f Behavir are accepted by vlunteers wh cmmit t an Ohi State University Extensin ( OSUE r Extensin ) prgram as a cnditin f their vlunteer status. The Standards f Behavir shall guide vlunteer s behavir during their invlvement in Extensin prgrams. Just as it is a privilege fr Ohi State University t wrk with individuals wh vlunteer their time and energies t the rganizatin, a vlunteer s invlvement with OSUE is a privilege and a respnsibility, nt a right. OSUE prvides quality educatinal prgrams accessible t all Ohi citizens. The primary purpse f this Standard f Behavir is t ensure the safety and well-being f all Extensin prgram participants (i.e., members, their parents and families, prfessinals, and vlunteers). Vlunteers are expected t functin within the guidelines f OSUE and the individual prgram area (4-H, Agricultural & Natural Resurces, Family & Cnsumer Sciences, and Cmmunity Develpment). Extensin vlunteers shall act with persnal integrity. Ohi State University Extensin vlunteers will: Uphld vlunteerism as an effective way t meet the needs f yuth and adults. Uphld each individual s right t dignity, self-develpment, and self-directin. Accept supervisin and supprt frm prfessinal Extensin staff while invlved in the prgram. Accept the respnsibility t represent their individual cunty Extensin prgram and The Ohi State University. Cnduct themselves in a curteus and respectful manner, exhibit gd sprtsmanship, and prvide psitive rle mdels fr all yuth. Respect, adhere t, and enfrce the rules, plicies, and guidelines established by their individual cunty Extensin prgram and OSUE. Nt engage in abusive behavirs that physically r verbally threaten r harm any Extensin prgram participant, including yuth. Nt engage in any act prhibited by law. Cmply with all civil rights laws and plicies, including but nt limited t OSUE equal pprtunity, anti- discriminatin laws, and prgram participant plicy. Perfrm duties in a respnsible and timely manner as utlined in the psitin descriptin. Immediately reprt any threats t the vlunteer s emtinal r physical well-being t the cunty Extensin prfessinal. Accept the respnsibility t prmte and supprt Extensin prgrams in rder t develp an effective cunty, state, and natinal prgram. Handle animals and perate machinery, vehicles, and ther equipment in a respnsible manner. I understand and agree that as a vlunteer: In accrdance with Ohi State University plicy, Self-Disclsure f Criminal Cnvictins Plicy 4.17, I am required t selfdisclse criminal cnvictins within three business days f the cnvictin. I will uphld and supprt the respnsible and lawful use f scial media. In s ding, I will nt create r pst scial media cntent that is abusive, threatening, defamatry, bscene, harassing, r creates a hstile envirnment. I will reprt any child abuse, sexual abuse, r neglect in accrdance with university plicy I will nt intentinally r purpsefully place myself in a psitin alne with a member f a vulnerable ppulatin in a nen-ne situatin, including, but nt limited t sleeping quarters with participants. I will nt, under any circumstances, physically, verbally, r emtinally abuse r fail t prvide the basic necessities f care, such as fd r shelter t participants. I will endeavr t prvide a safe and healthy prgram/camp experience fr all participants. My vlunteer status is subject t immediate suspensin r terminatin based n any act r missin that Extensin determines t be cntrary t any prtin f these standards r therwise in cnflict with the gals f OSUE. I have read, understand, and agree t be bund by the VOLUNTEER STANDARDS OF BEHAVIOR utlined abve. Vlunteer Signature Date CFAES prvides research and related educatinal prgrams t clients n a nndiscriminatry basis. Fr mre infrmatin: { }Ver.10/ TGrdy

9 Ohi State University Extensin Highland Cunty Cllege f Fd, Agriculture and Envirnmental Sciences 119 Gvernr Fraker Place Suite 202 Hillsbr, Ohi Phne Fax highland.su.edu 4-H Vlunteer Criminal Histry Fingerprint Backgrund Check Prcedure Please take this page with yu when yu g t have yur backgrund check. In Highland Cunty, 4-H vlunteers shuld have their backgrund check dne at: Highland Cunty Sheriff s Department 130 Hmestead Drive Hillsbr, OH tape receipt in this area Please be prepared t pay $30.00 (cash r check, credit/debit card is nt accepted). What Yu Need t Get Yur Ohi 4-H Backgrund Check 1. A gvernment issued pht ID - such as yur driver s license - with yur current address, and shwing yur date f birth. 2. Yur Scial Security number - Knw yur number? N need t bring yur SS card. 3. Use as the reasn cde yu are having the backgrund check. 4. If yu have nt lived in Ohi fr the past 5 years, yu must als have an FBI reprt. 5. Backgrund check results must be mailed t: 6. Attentin: Backgrund Checks 4-H HIGHLAND COUNTY OSU Office f Human Resurces 1590 N. High St., Ste. 300 Clumbus, Ohi If the agency is nt able t get a gd scan f yur fingerprints, please ask fr an inked fingerprint card. Yu will then bring the inked card t the Extensin ffice. Nte: The fingerprint backgrund check prcess reveals past criminal cnvictins. The Ohi Revised Cde specifies certain criminal cnvictins as disqualifying events that frbid current and future vlunteer invlvement with Ohi 4-H and OSU Extensin. Yu can view this list at: If yu wuld like t be reimbursed fr the cst f yur backgrund check, keep yur riginal receipt and bring it, alng with this frm, t yur cunty OSU Extensin ffice. Cmplete the frm belw and be sure yur name appears n yur receipt. We will submit a reimbursement request fr yu. The check will be mailed frm OSU in Clumbus; it may take eight t ten weeks t prcess and will nt say 4-H, but OSU. OSU Extensin 4-H Vlunteer Request fr Reimbursement Vlunteer Name (Print first, middle, last): Vlunteer Signature: Date: Fr ffice use nly. Tape receipt t tp f this frm befre scanning. Date vlunteer reimbursement request received at Extensin Office: (mnth / day / year) Name & initials f OSU Extensin Prfessinal receiving request: Initials: CFAES prvides research and related educatinal prgrams t clientele n a nndiscriminatry basis. Fr mre infrmatin: