MISSOURI Master Naturalist™ PROGRAM
ENROLLMENT FORM
This program is a collaborative effort
between the Missouri Department of Conservation and University of Missouri
Extension.
MERAMEC HILLS CHAPTER
MISSOURI MASTER NATURALIST
C/O PHELPS COUNTY EXTENSION
200 N. MAIN
ROLLA, MO 65401
Enrollment begins 8 July 2009. Participation will be considered on a first come, first served basis. Participants must be at least 18 years of age. Please type or print clearly and return your form to the above address. An enrollment fee of $100 must accompany the application.
Make check payable to: PHELPS COUNTY
EXTENSION
NAME:________________________________________ (As
you wish it to appear on your certificate)
Name:_________________________________________ (As you wish it
to appear on your nametag—if different from above)
MAILING ADDRESS:
Street_______________________________
City_________________County________________ Zip
Code____________
Telephone: Day
(___)____________Evening: (___)____________
E-MAIL ADDRESS
(optional):_______________________________
OCCUPATION, if
employed:______________________________________
If retired, what was your former
occupation?_______________________________________
VOLUNTEER EXPERIENCE, if any
(not a prerequisite for participation):
1) Describe why you are interested in
the Missouri Master Naturalist Volunteer program.
2) What skills or interests are you
willing to contribute to the Missouri Master Naturalist Programs? (Skills may
include computer, photography, typing, graphic arts, public speaking, teaching,
specific knowledge, etc.)
_________(Initial
here) If accepted into this
program, I understand I am required to undergo a confidential screen for child
abuse & neglect and criminal records before I begin my volunteer work, in
keeping with the necessity for ensuring the safety of youth as well as
providing protection for all volunteers. I understand that I may
participate in the initial 40 hour training course but will not be recognized
as a Master Naturalist until the records-checking process is completed and I
am notified in writing of my acceptance into the program. I am assured that
this process will be handled with the highest degree of confidentiality.
_________(Initial
here) YES I will be available to
attend all class sessions and field trips as listed on the training schedule. I
understand that I am required to attend the training class, complete 40 hours of
volunteer service within 15 months of beginning training and complete 8 hours of
approved advanced training in order to become a Certified Missouri Master
Naturalist.
_________(Initial
here) NO, I cannot make the
commitment required to participate at this time, but I am still interested in
the program. Please contact me when the next course is offered.
MERAMEC HILLS CHAPTER OF THE
MISSOURI Master Naturalist PROGRAM VOLUNTEER COMMITMENT:
I understand that in exchange for
the training made possible through the
[CHAPTER NAME] Chapter of the Missouri Master Naturalist program, I will
volunteer at least 40 hours of my time toward approved projects and
successfully complete 8 hours of advanced training within 15 months of the
start of the course. I understand that I will become a Certified Missouri
Master Naturalist when I complete both the training and the volunteer work.
I also understand that to maintain an active status, I must successfully
complete 8 hours of advanced training and 40 hours of volunteer service each
year thereafter.
Signature________________________________________ Date_________________