4-H Healthy Living Ambassador Application

4-H Healthy Living Ambassador Garden Program Application

Ages 13-19

Applications and recommendation form or recommendation letter due February 27, 2015.

Recommendations can be emailed to 4hyouthinaction@ucanr.edu or mailed to 80 Stone Pine Rd. Suite 100, Half Moon Bay, CA 94019

Elkus Ranch Training Saturday, March 14 at 10am through Sunday March 15 at 3pm

FIND PROGRAM INFORMATION HERE

✻ = Required

Personal Information

First Name ✻

Last Name ✻

Birthday ✻

Home Phone ✻

Cell Phone

School Name ✻

Current Grade ✻

Home Address

Use the location search to find the location

Location Search ✻

Address ✻

Address 2

City ✻

State ✻

Postal Code ✻

Country ✻

Do you speak an other language/s besides English? ✻

Yes No

If yes, which language/s?

Availability:

The program will be carried out from March-May afterschool.

Please provide your afterschool availability (example 3:00-6:00pm)

Monday

Tuesday

Wednesday

Thursday

Friday

Do you live, go to school near, or have transportation to any of the following elementary schools or programs? ✻

Fair Oaks Elementary, Redwood City Hatch Elementary, Half Moon Bay El Granada Elementary, Half Moon Bay JFK Elementary, Daly City FDR Elementary, Daly City George Washington Elementary, Daly City Ecumenical Hunger Program, East Palo Alto I do not live or go to school near any of these locations

Are you available to attend the MANDATORY program training on Saturday, March 14th and Sunday, March 15th at ELKUS RANCH in Half Moon Bay? The training will begin on Saturday at 10am and go through Sunday at 3pm. If you are unavailable to attend this training you will not be an eligible candidate for the program. ✻

Yes No

Do you have available transportation to Elkus Ranch for the training? ✻

Yes No

Would your parent or guardian be interested in attending/chaperoning the training at ELKUS Ranch in Half Moon Bay? ✻

Yes No

If yes, please provide contact information for your parent or guardian

Parent Name

Home phone

Cell phone

Association with teen

Would you be interested in participating in other UC Cooperative Extension sponsored extracurricular activities during the program? ✻

Yes No

Please complete the following quesitons with detailed responses and a minimum of 3-4 sentences.

Why are you interested in the Teen Ambassador program? ✻

Have you ever worked with youth or children? If yes, please tell us about your experiences. ✻

What work experience/tutoring/technology experience do you have? Please include any computer software programs that you are comfortable with. ✻

Do you have any experience with gardening or have you participated in any extracurricular physical activities? Please explain. If not, why are you interested in these areas? Please explain ✻

What are some of your strengths? How do you use these strengths in a group environment? ✻

What are some of your weaknesses? What are your strategies for overcoming these weaknesses? ✻

What are your expectations for this position? ✻

What do you hope to learn from this experience? ✻

Recommendation form or letter:

Please attach a recommendation form or one recommendation letter (one page maximum) from someone not related to you. You can also email recommendations to 4hyouthinaction@ucanr.edu or mail them to 80 Stone Pine Rd. Suite 100, Half Moon Bay, CA 94019

Recommendations and applications are due by February 27, 2015.

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