Form 4-H - Michigan Volunteer Authorization - Msu Extension
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2Michigan 4-H Volunteer Authorization Form
Volunteer Name: ________________________________________________________________
County of 4-H Participation: _____________________________Program Year: 20____-20____
Instructions: This two-page form is required for participation in Michigan State University Extension 4-H youth
programs. Each section requires a separate authorization.
SECTION 1- Required
Michigan 4-H Volunteer Code of Conduct
As an MSU Extension volunteer, I promise that I will:
Accept responsibility to represent Michigan 4-H and MSU Extension programs with
dignity and pride by being a positive role model.
Respect, adhere to, and enforce the rules, policies and guidelines established by local,
state and national 4-H and MSU Extension programs, and be courteous and respectful in
dealings with other program participants and MSU staff.
Abstain from, and not tolerate physical or verbal abuse of others through direct
interactions or through use of social media or other communication venues.
Comply with equal opportunity and anti-discrimination laws.
Avoid criminal activities.
Under no circumstances, possess, sell or consume alcohol or possess, sell or use
controlled substances at an MSU Extension activity or event.
Refrain from the use of tobacco, tobacco products, electronic cigarettes, etc. while serving
in a volunteer capacity at 4-H activities.
Under no circumstances, attend or participate in an MSU Extension activity or event
under the influence of alcohol and/or other controlled substances.
Operate machinery, vehicles and other equipment in a responsible manner.
Report a violation of the Code of Conduct of which I am aware to a MSU Extension staff
member or the person in charge of the program.
It is expected that all Michigan State University Extension volunteers comply with the Code of Conduct.
Failure to comply with any component of the code or participation in other inappropriate conduct as
determined by MSU Extension representatives may lead to dismissal as a volunteer from the MSU
Extension program
Volunteer Signature: ________________________________________ Date: ______________
SECTION 2- Required
Evaluation Acknowledgement
As a volunteer in the Michigan State University Extension/ 4-H program, you may be asked to help with
the evaluation of the program. You may be asked to complete a short survey about what you learned or
did as a result of the program. Surveys could be given before the program begins and/or after the
program has ended. Surveys typically take no more than 10 minutes to complete. All surveys are
confidential. You are not required to participate in a survey. If you do not wish to participate, it will not
affect involvement in any programs of Michigan State University. If you do not want to participate in
program evaluations or have questions about the evaluation, contact your local 4-H coordinator at the
MSU Extension Office.
Volunteer Signature: ________________________________________ Date: ______________
MSU is an affirmative-action, equal-opportunity employer. Michigan State University Extension programs and materials are open to
all without regard to race, color, national origin, gender, gender identity, religion, age, height, weight, disability, political beliefs,
sexual orientation, marital status, family status or veteran status.
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