2022 4-H Exploration Days Session Submission
DOWNLOAD FILENovember 1, 2021 - Author: Michigan State University Extension
Below you will find the questions on the online 2022 4-H Exploration Days Session Submission form. All submissions should be submitted through the online form. However, this document is being provided to help volunteers preview and plan for their online submission.
2022 Exploration Days Session Submission Form
Thank you for applying to teach at the 2022 Michigan State University Extension 4-H Exploration Days taking place June 22 to 24, 2022 on the campus of Michigan State University. We are so excited for your interest in our program.
We are accepting session proposals on Thursday, June 23 and Friday, June 24.
The request for sessions is open until December 15 and we let you know if your submission has been chosen as part of the 2022 schedule by early 2022. Chosen sessions will receive a second survey in 2022 to finalize session information.
Contact information for the primary session instructor. This person will serve as the point of contact.
First Name ________________________________________________________________
Last Name ________________________________________________________________
Preferred mailing address ____________________________________________________
City _____________________________________________________________________
Postal code _______________________________________________________________
Cell phone number (will not be shared, but may be used on the day of the event in case of emergency) _______________________________________________________________
Daytime phone number ______________________________________________________
Email address _____________________________________________________________
Are you a Michigan State University employee?
Yes
No
If you have worked with MSU Extension staff members in the past (with Exploration Days or with other programming), please list their names here:
____________________________________________________________________________
Have you read and agree to the MSU Extension 4-H Exploration Days Session Instructor Role Description?
Yes
No
How many times (would you guess) you have taught at Exploration Days before?
I have not taught at this event before.
1-3 times
4-6 times
7-10 times
More than 10 times
Are you a registered Michigan State University Extension Volunteer (4-H, Master Gardener, Health and Nutrition, etc) as a Gold volunteer?
Yes
No
Maybe
Session Title
____________________________________________________________________________
Session Description (about 3-5 sentences max)
____________________________________________________________________________
How many times are you willing to teach this session?
1 time
2 times
3 times
What is your maximum number of youth participants?
__________
What session date/length are you willing/available to teach this session at (select all that apply)? Note:
- Field trips off campus are only for sessions held on Thursday (Session C) due to timing.
- Busing to an on-campus location is available for all sessions.
Session A: Thursday, June 23 from 8:30am-11:30am (3 hour session)
Session B: Thursday, June 23 from 1:30pm-4:30pm (3 hour session)
*Session C: Thursday, June 23 from 8:30am-11:30am AND 1:30pm-4:30pm (6 hour session)
Session D: Friday, June 24 from 8:30am-11:00am (2 1/2 hour session)
What age range of participants is this session appropriate for? (Exploration Days participants will be 12- 19 years old so, if a specific age range is preferred, please note.)
____________________________________________________________________________
Is a $5 per youth budget sufficient for your program?
Yes
No. If no, what do you anticipate will be the cost per participant? ________________________________________________
Would you need busing to an on-campus location (such as the Pavilion, the Bakery, Barns, etc) or nearby vicinity during your session?
Yes. Please describe. _______________________________________________________
No
Field trips off campus are only for sessions held on Thursday (Session C) due to timing. You previously selected a Thursday session, will you take a field trip off campus?
Yes
Maybe
No
Would you be willing to teach this session virtually? (check all that apply)
Yes- live virtual
Yes- pre-recorded video
Yes- independent learning content (asynchronous)
Maybe
*No
How will you make this program interactive, incorporate hands-on learning experiences for youth, and fill the full time slot?
____________________________________________________________________________
Is there any other information you want to provide about your session?
____________________________________________________________________________
Do you have any youth or adult session support? This includes co-instructors, youth helpers, adult co-facilitators.
Yes
No
How many session support people do you have names for at this time?
- I know I will have support, but have no names at this time.
1
2
3
4
5
6
7
Enter the information for support contact 1 below
Is this a youth or adult session support?
Youth
Adult
Session Support's contact information
First name ________________________________________________________________
Last name ________________________________________________________________
Email address _____________________________________________________________
Phone number (cell preferred) _________________________________________________
Has this individual gone through the MSU Extension Volunteer Selection Process as a Gold volunteer?
Yes
Maybe
No
Enter the information for support contact 2 below
Is this a youth or adult session support?
Youth
Adult
Session Support's contact information
First name ________________________________________________________________
Last name ________________________________________________________________
Email address _____________________________________________________________
Phone number (cell preferred) _________________________________________________
Has this individual gone through the MSU Extension Volunteer Selection Process as a Gold volunteer?
Yes
Maybe
No
Enter the information for support contact 3 below
Is this a youth or adult session support?
Youth
Adult
Session Support's contact information
First name ________________________________________________________________
Last name ________________________________________________________________
Email address _____________________________________________________________
Phone number (cell preferred) _________________________________________________
Has this individual gone through the MSU Extension Volunteer Selection Process as a Gold volunteer?
Yes
Maybe
No
Enter the information for support contact 4 below
Is this a youth or adult session support?
Youth
Adult
Session Support's contact information
First name ________________________________________________________________
Last name ________________________________________________________________
Email address _____________________________________________________________
Phone number (cell preferred) _________________________________________________
Has this individual gone through the MSU Extension Volunteer Selection Process as a Gold volunteer?
Yes
Maybe
No
Enter the information for support contact 5 below
Is this a youth or adult session support?
Youth
Adult
Session Support's contact information
First name ________________________________________________________________
Last name ________________________________________________________________
Email address _____________________________________________________________
Phone number (cell preferred) _________________________________________________
Has this individual gone through the MSU Extension Volunteer Selection Process as a Gold volunteer?
Yes
Maybe
No
Enter the information for support contact 6 below
Is this a youth or adult session support?
Youth
Adult
Session Support's contact information
First name ________________________________________________________________
Last name ________________________________________________________________
Email address _____________________________________________________________
Phone number (cell preferred) _________________________________________________
Has this individual gone through the MSU Extension Volunteer Selection Process as a Gold volunteer?
Yes
Maybe
No
Enter the information for support contact 7 below
Is this a youth or adult session support?
Youth
Adult
Session Support's contact information
First name ________________________________________________________________
Last name ________________________________________________________________
Email address _____________________________________________________________
Phone number (cell preferred) _________________________________________________
Has this individual gone through the MSU Extension Volunteer Selection Process as a Gold volunteer?
Yes
Maybe
No
