PYD Committee Membership Application

PYD Committee Application - Volunteer and Professional Capacity Building Working Group

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* 1. Your Name

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* 2. Your e-mail address

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* 3. Your phone number

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* 4. Your LGU

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* 5. Please indicate your LGU Region

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* 6. On a scale of 1 to 10, how confident are you that you will have the time required to participate actively in this working group?

Not too confident- but I hope to have time

Very confident - this will be a priority for me time wise

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 7. Please describe your interest, qualifications, and why you want to be a member of the PYD Committee Professional and Volunteer Capacity-Building Working Group.

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* 8. Which of the following best matches your Extension 4-H position?

State program leader

State 4-H specialist

State 4-H staff

County 4-H educator (agent, advisor) - faculty position

County 4-H educator- non faculty position

Other (please specify)

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* 9. Please indicate that you meet all the requirements for this position:

	Yes	No
4-H professional status	4-H professional status Yes	4-H professional status No
Desire to establish a consistent model of PYD across the 4-H system based on the 4-H Thriving Model	Desire to establish a consistent model of PYD across the 4-H system based on the 4-H Thriving Model Yes	Desire to establish a consistent model of PYD across the 4-H system based on the 4-H Thriving Model No
Experience in leading professional capacity building efforts	Experience in leading professional capacity building efforts Yes	Experience in leading professional capacity building efforts No
Commitment to a three-year term	Commitment to a three-year term Yes	Commitment to a three-year term No
Commitment to active participation in, and contribution to, the working group annual plan of work.	Commitment to active participation in, and contribution to, the working group annual plan of work. Yes	Commitment to active participation in, and contribution to, the working group annual plan of work. No
Available dedicated time for participation (approximately 5-10 hours/month)	Available dedicated time for participation (approximately 5-10 hours/month) Yes	Available dedicated time for participation (approximately 5-10 hours/month) No
Confidence in teaching and leading	Confidence in teaching and leading Yes	Confidence in teaching and leading No
Support from State 4-H Program leader	Support from State 4-H Program leader Yes	Support from State 4-H Program leader No
Support from immediate supervisor (if not the State 4-H Program Leader)	Support from immediate supervisor (if not the State 4-H Program Leader) Yes	Support from immediate supervisor (if not the State 4-H Program Leader) No