Appendix B.18. Re-Application/Transfer Form
Name, Title
XXXXCounty Office
OSU Extension Service
Address
City, OR ZIP
Txxx-xxx-xxxx | Fxxx-xxx-xxxx | E
URL of Homepage
Master Gardener™ Program
OSU Extension Service/XXXXCountyMasterGardner
Reapplication/Transfer form
Name ______
Address ______
City______State ______Zip______
Phone ______Fax ______
Email ______
Emergency contact Name ______Phone ______Relationship______
Year you took MG training ______Where______
Years of Gardening Experience ______
Please list any specialized garden related training you have received: ______
______
Do you need any special accommodations in order to participate in training or other program activities? _____
If yes, what? ______Do you require handicapped parking? _____
Which of the following activities/programs are your interested in?
___ Recertification classes held weekdays ___ Weekend Recertification Classes
___ Open book recertification test
___ Do you have an OSU Extension Master Gardner Program badge?
___ Please order me a MG Program badge ($10.00) the badge will be mailed to as soon as your check is received.
Please list the Extension Agent/Coordinator of Master Gardner Program that supervised your training.
Name ______
Address ______
City______State ______Zip______
Phone ______Fax ______
Email ______
Ask applicants to list skills and 2 – 3 references you can contact.
We will endeavor to provide public accessibility to services, programs and activities for people with disabilities. If accommodation is needed to participate at any meeting, please contact the ADA Coordinator at the XXXXCounty office of OSU Extension Service at XXX-XXX-XXX at least two-weeks prior to the scheduled meeting time.
Oregon State University Extension Service offers educational programs, activities, and materials—without discrimination based on race, color, religion, sex, sexual orientation, national origin, age, marital status—as required by Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, and Section 504 of the Rehabilitation Act of 1973. Oregon State University Extension Service is an Equal Opportunity Employer.