Ohio State University Extension

Ohi State University Extensin Brwn Cunty 325 W. State Street Bldg. B Gergetwn, OH 45121 937-378-6716 Phne 937-378-6646 Fax brwn.su.edu Dear Ptential Ohi 4-H Vlunteer, Let me take this pprtunity t thank yu fr expressing an interest in becming an Ohi 4- H vlunteer. Each year, mre than 25,000 adult and teen vlunteers cntribute their time, energies, and talents that enable Ohi 4-H t reach nearly 300,000 yuth, helping Ohi 4-H fulfill its missin f helping yuth t becme caring, capable, and cntributing citizens. 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 Ohi 4-H members, parents, vlunteers, and prfessinals, 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 webcheck fingerprint recrd check (6) agree t and sign the vlunteer standards f behavir frm (7) participate in an rientatin/training prgram, which includes mandatry child prtectin training 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 per Ohi State recrds retentin requirements. 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, Christy D. Clary Extensin Educatr 4-H Yuth Develpment

OHIO STATE UNIVERSITY EXTENSION Prcedure fr Vlunteer Screening Fr All Ptential 4-H Vlunteers in Brwn Cunty The fllwing steps need t be taken by all ptential 4-H Vlunteers prir t acting in the capacity f a 4-H Vlunteer Leader/Adviser in Brwn Cunty: 1. Pick up the 4-H Vlunteer packet at the OSU Extensin, Brwn Cunty Office lcated at 325 W. State Street, Bldg. B, Gergetwn, OH. Our ffice hurs are Mnday-Friday 8am-4:30pm. Or dwnlad the packet frm ur website (http://brwn.su.edu). The packet includes: 1) General 4-H Vlunteer Psitin Descriptin; 2) Vlunteer Applicatin Frm; 3) Standards f Behavir; 4) Infrmatin fr cmpleting the required backgrund check. 2. Cmplete the applicatin, sign the standards f behavir and submit bth frms t the Extensin ffice. Our ffice will send letters t the listed references. Applicants will want t fllw up with references, reminding them that it is imprtant t return the reference frm t the Extensin Office as sn as pssible. Yur applicatin is nt cmplete until all reference frms are received. 3. The applicant must submit t a mandatry criminal backgrund check. Infrmatin n hw t btain the required backgrund check is included in the applicatin packet r can be picked up frm the Extensin Office. All applicatin materials must be received by the OSU Extensin Office by April 1 st, 2017, this includes references and backgrund check. We will receive electrnic cnfirmatin when yur backgrund check is received by OSU Extensin. If we have nt received this cnfirmatin by April 1 st, we will accept prf in the frm f a cpy f yur receipt shwing it was cnducted. 4. Schedule and interview and cmplete a NEW 4-H Vlunteer Orientatin. Please nte, attending a returning vlunteer update des nt meet the requirement fr a new vlunteer. New vlunteer rientatin dates will be annunced in early 2017. Please check ur website r cntact the Extensin Office fr mre infrmatin n these dates. 5. Fllwing the cmpletin f the abve steps, the applicant will receive a letter frm OSU Extensin indicating ne f the fllwing: 1) the applicant has been accepted; 2) the applicant has nt been accepted; r 3) Mre infrmatin is needed prir t making a decisin. An individual is NOT t act in the capacity f a 4-H Vlunteer until they receive an acceptance letter; the rganizatinal adviser f the club will als receive a cpy f this letter. 6. Acceptance as a 4-H vlunteer des nt autmatically give the individual the right t became an adviser in the club f ne s wn chsing. If an applicant is interested in becming an adviser in an already established club, the ptential vlunteer must gain permissin t be an adviser in a specific club frm the clubs rganizatinal adviser. brwn.su.edu CFAES prvides research and related educatinal prgrams t clientele n a nndiscriminatry basis. Fr mre infrmatin: g.su.edu/cfaesdiversity.

OHIO STATE UNIVERSITY EXTENSION Psitin Title: 4-H Club Vlunteer (Prject and Activity) Time Required: On-ging Vlunteer Psitin Descriptin 4-H Yuth Develpment Ohi State University Extensin General Purpse: Supprt and wrk in partnership with 4-H prfessinals, vlunteers and members in cnducting meaningful educatinal experiences t help yuth grw and reach their fullest ptential. Specific Respnsibilities: Prvide a variety f 4-H prject related learning experiences, including: Crdinate and cnduct educatinal activities related t prject areas. Mnitr prgress twards prject cmpletin. Prepare members fr judging, skillathn, and exhibitin Infrming members f prject requirements, deadlines, and events & activities. Prvide cnstructive feedback t members, parents, and families. Advise members in crdinating/cnducting club activities, including: Cmmunity service, fund raising, club trips & turs, recreatinal activities, achievement prgrams, prmtinal activities, parent s night and thers. Prmte 4-H pprtunities in yur club and lcal cmmunity, including: Encurage 4-H members and parents interest and participatin. Invite parents ideas, cperatin, supprt and attendance at 4-H activities. Recruit new members when the club has penings. Infrm members f cunty 4-H events & activities. Actively participate as a vlunteer by: Fllw OSU Extensin and 4-H Yuth Develpment guidelines and plicies. Attending all (r mst) f the club meetings and activities. Read 4-H mailings and access infrmatin frm the 4-H web t keep members, parents and/r ther vlunteers infrmed. Participate in vlunteer develpment pprtunities. 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) brwn.su.edu CFAES prvides research and related educatinal prgrams t clientele n a nndiscriminatry basis. Fr mre infrmatin: g.su.edu/cfaesdiversity.

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: Email: 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.

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 13-19 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

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 e-mail addresses. Name: Street Address: Email: Relatinship: City/State/Zip: Phne: Name: Street Address: Email: Relatinship: City/State/Zip: Phne: Name: Street Address: Email: 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

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: http://g.su.edu/cfaesdiversity. {00211535-2}Ver.10/14.1 - TGrdy

4-H Vlunteer Criminal Histry Fingerprint Backgrund Check Prcedure Please take this page with yu when yu g t have yur backgrund check. In Brwn Cunty, 4-H vlunteers shuld have their backgrund check dne at: Ohi State University Extensin Brwn Cunty 325 W. State Street, Bldg. B Gergetwn, OH 45121 937-378-6716 Phne 937-378-6646 Fax brwn.su.edu t a p e r e c e i p t i n t h i s a r e a Brwn Cunty Sheriff s Office: 750 Mt. Orab Pike Gergetwn, OH 45121 Phne: 937-378-4435 Brwn Cunty Educatin Service Center: 9231 Hamer Rd. Gergetwn, OH 45121 Phne: 937-378-6118 Ohi Valley Manr, Inc. 5280 Rt. 62-68 Ripley, OH 45167 Phne: 937-392-4318 Please call ahead t find ut hurs they perfrm backgrund checks r t schedule an appintment. Please be prepared t pay $30.00 (cash r check 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 2151.86 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 a FBI reprt. 5. Backgrund check results must be mailed t: Attentin: Backgrund Checks Brwn Cunty OSU Office f Human Resurces 1590 N. High St., Ste. 300 Clumbus, Ohi 43201 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: http://g.su.edu/dqffenses. 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 then submit a reimbursement request fr yu. The reimbursement check will be mailed frm OSU in Clumbus; it may take eight t ten weeks t prcess. 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: