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2022 Free TIme Exploration Days Form

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November 1, 2021 - Author:

Below you will find the questions on the online 2022 4-H Exploration Days Free Time 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 Free Time Exploration Days Form

Thank you for applying to lead a free time activity 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 proposals for free time activities (for evening hours on June 22 and 23.) Free-time activities will be drop-in choices for youth.

The request for free time activities is open until April 1st and we let you know if your submission has been chosen as part of the 2022 event by May 1st. A follow-up may be sent to chosen free time activities to finalize details.

Contact information for the primary free time 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

Free Time Activity Title

____________________________________________________________________________

Free Time Description (about 3-5 sentences max)

____________________________________________________________________________

Do you have a maximum number of youth that could attend?  If yes, what would that number be?

Yes ________________________________________________

No

What time(s) would you be willing to offer this free time opportunity? (You can select more than once if you are open to running the activity at a variety of times.)

Wednesday, June 22 8:30-9:30pm

Wednesday, June 22 8:30-10pm

Thursday, June 23 7:00-8:00pm

Thursday, June 23 8:00-9:00pm

Thursday, June 23 9-10:00pm

Would you be willing to run the free time activity more than once?

Yes

No

Will there be a cost to this free time activity?  If so, how much would you anticipate? Limited funds are available.

Yes ________________________________________________

No

Is there anything else you would like us to know about your free time activity?

____________________________________________________________________________

Do you have any youth or adult free time support?  This includes co-instructors, youth helpers, adult co-facilitators.

Yes

No

How many free time support people do you have names for at this time?

  1. 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 free time support?

Youth

Adult

Free Time 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 free time support?

Youth

Adult

Free Time 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 free time support?

Youth

Adult

Free Time 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 free time support?

Youth

Adult

Free Time 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 free time support?

Youth

Adult

Free Time 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 free time support?

Youth

Adult

Free Time 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 free time support?

Youth

Adult

Free Time 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

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Tags: 4-h, 4-h exploration days, msu extension, volunteering & mentoring

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