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Appendix E 175
JMG Registration PacketThe forms described below are used in registering youths and leaders in the Junior Master Gardener program and for ordering completion certificates.
1. Junior Master Gardener Registration Agreement Form. The JMG Registration Agreement Form registers a properly organized and functional JMG group. The registration serves as a permit for use of the 4-H and JMG service marks, names, logos and emblems. It allows a group to function with all the rights and privileges of 4-H/JMG membership.
2. Junior Master Gardener Member Group Enrollment Form (JMG 1-5.061). The JMG program is expected to reach thousands of youths across the nation. To document each youth’s participation in the program, the teacher and/or leader must complete form JMG 1-5.061 for each group. JMG 1-5.061 will provide statistical data for state and federal governments for future funding and civil rights documentation.
Use these guidelines when completing the Junior Master Gardener Member Group Enrollment Form:County name: County in which the JMG program is being conductedJMG group name: This name can be created by the youths (something catchy or related to region).JMG group teacher/leader: Name of classroom teacher and/or leader (A registration form must be included for each person named.)
SECTION I: Unit Information
The JMG program can be organized in several ways:Community: A community 4-H club having club officers, regular monthly meetings, a community service project, project meetings, a club manager, parental participation and project leaders.
Project: Same as a community club, except that it concentrates on only one project and expands into other projects after the original one.
School: Same as community club, except that it is organized and conducted in school; members may be divided into several clubs of different ages.
Community Has the same structure as a community club and can be delivered in a school Partnership: setting. However, the lead volunteers managing the club come from at least two other distinct organizations whose goal or project is to work with youths (e.g., Lions Club, Key Club, etc.).
Special Interest: Organized or coordinated by Extension personnel and directed and/or taught by volunteer adult or youth leaders. The meetings are conducted in informal classroom settings with members participating in at least 20- to 60-minute learning sessions with the total learning time of at least two hours.
Curriculum A learning activity in a classroom setting, led by school faculty, a staff member or Enrichment: a volunteer. The project consists of at least six learning experiences, each 20 to 60 minutes long. It uses the 4-H clover and promotes other delivery methods in which youths can participate.
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176
Camping: Youth program in a structured, informal setting ranging from one full day to overnight.
ENP-Y: (Expanded Nutrition Program - Youth). Program designed to teach good nutrition and health. This program involves youths in all aspects of food production and consumption and can be delivered at schools as curriculum enrichment, in after- school programs or neighborhood groups, at recreation centers and summer day camps, and/or as displays at community health fairs.
Clover Kids (K-2): Informal educational program for youths ages 5 to 8 in kindergarten, first and second grades. This program is an introductory 4-H program for boys and girls.
SECTION II—Distribution of Members:
Record information in this section as accurately as possible. Make sure that each person in the project is accounted for and that the totals in all four boxes match. If the RACE AND GENDER Section reflects that all participants are of the same race, then please complete the two questions under the box. This will provide civil rights documentation concerning the setting of the project and its accessibility to all races and sexes.
3. Junior Master Gardener Leader/Teacher Registration Form (JMG 2-1.056). All teachers and volunteers must complete this form, which will be used to gather statistical information on all volunteers and teachers in the program. The back of the registration form is an optional volunteer screening process. After completing these forms, school teachers and officials are strongly encouraged to review the information about all volunteers before beginning the program.
The teachers and/or volunteer leaders should complete this form at the beginning of each new class of Junior Master Gardeners.
You will receive an official letter of registration for your group from the JMG program headquarters. A copy of your Registration Packet will be sent to your local Extension office for its records.
4. JMG Completion Form. Mail the completed JMG Publication Order Form plus your check or money order for the publications to JMG Distribution. All other forms in the JMG Registration Packet should be mailed to the Junior Master Gardener headquarters.
Junior Master Gardener Headquarters JMG Distribution 225 HFSB 4066 State Hwy 6 South 2134 TAMU College Station, TX 77845 College Station, Texas 77843-2134 1-888-JMG-KIDS (979) 845-8565 Fax: (979) 690-7547 Fax: (979) 845-8906 E-mail: [email protected]
When members of your group complete the JMG curriculum requirements, order JMG certificates by completing the JMG Completion Form and mailing it to the national JMG program headquarters. Certificates will be returned promptly so you can present them to the newest Junior Master Gardeners.
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Appendix E 177
Please complete and returnthe following four pages.
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178 Registration 1 of 4
JMG Junior Master GardenerRegistration Agreement Form
We request through this Registration Agreement Form to be an official JMG group. Our grouphas met all of the following criteria: 1. A minimum of five youths 2. One or more adult teacher/leader(s) 3. Suitable meeting facilities (classroom, garden area) 4. An official club or group name (JMG office reserves the right to modify name)
JMG group name desired _____________________________________________________________________
JMG site __________________________________________________________________________________
County where JMG group is located ____________________________________________________________
Designated JMG teacher/leader __________________________________ Date _______________________
Address _________________________________________________ Telephone ____________________
_________________________________________________ E-mail ______________________ City State ZIP (Notify of any address changes)
Submitting this form:The group teacher/leader should complete this form and submit it to the national JMG program headquarters at Texas A&M University: Junior Master Gardener Program 225 Horticulture/Forestry Science Building 2134 TAMU College Station, Texas 77843-2134 Phone: (979) 845-8565 Fax: (979) 845-8906
Educational programs conducted by Texas Cooperative Extension serve people of all ages regardless of socioeconomic level, race, color, sex, religion, disability, or national origin.
Check:
I have read the JMG Management Guide and agree to follow the JMG guidelines.
I agree to assist in protecting the service marks and copyright of the JMG program as described.
________________________________________________JMG teacher/leader signature Date
®
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®®
179Registration 2 of 4
J
MG
Jun
ior M
aste
r G
arde
ner
Lead
er/T
each
er R
egis
trat
ion
Form
J
MG
Gro
up N
ame
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____
____
____
____
____
____
____
U
nit/C
lub
Num
ber _
____
____
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JMG
2-1
.065
Che
ck p
refe
renc
e
M
r.
M
rs.
Ms.
Dr.
Nam
e___
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
___
(L
ast)
(F
irst
)
(Mid
dle
Initi
al)
Mai
ling
Add
ress
____
____
____
____
____
____
____
____
____
____
____
____
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_
City
/Tow
n__
____
____
____
____
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____
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____
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_
Z
ip C
ode_
____
____
____
____
__
Phon
e N
umbe
r: H
ome_
____
____
____
____
____
____
____
_
W
ork
E-m
ail A
ddre
ss:_
____
____
____
____
____
____
____
____
____
____
____
__
M
ale
F
emal
e
A
dult
Y
outh
Thi
s in
form
atio
n is
requ
este
d to
gat
her s
tatis
tics
for
com
plia
nce
with
non
disc
rim
inat
ion
requ
irem
ents
.
C
heck
onl
y on
e
1.
Am
eric
an In
dian
or A
lask
an N
ativ
e
2
Asi
an o
r Pac
ific
Isla
nder
3.
B
lack
- no
t His
pani
c or
igin
4.
H
ispa
nic
5.
W
hite
- no
t of H
ispa
nic
orig
in
Res
iden
ceC
heck
onl
y on
e
1.
R
ural
/Far
m
2.
Tow
n le
ss th
an 1
0,00
0
3.
City
bet
wee
n 10
,000
and
50,
000
4.
Su
burb
of c
ity m
ore
than
50,
000
5.
C
entr
al c
ity m
ore
than
50,
000
Typ
e of
4-H
Uni
t C
heck
onl
y on
e
1.
C
omm
unity
2.
Pr
ojec
t
3.
Scho
ol
4.
Com
mun
ity P
artn
ersh
ip
5.
Clo
ver K
ids
(K-2
)
6.
Spec
ial I
nter
est
7.
C
urri
culu
m E
nric
hmen
t
8.
Cam
ping
9.
E
NP-
Y
Maj
or L
eade
rshi
p R
espo
nsib
ility
1.
C
lub
Man
ager
2.
Pr
ojec
t Lea
der
3.
A
ctiv
ity L
eade
r
4.
JMG
Vol
unte
er (s
peci
fy)
__
____
____
____
____
____
_
5.
Oth
er (s
peci
fy)
__
____
____
____
____
____
_
4-H
Alu
mni
:
Yes
No
Stat
e __
____
____
____
____
__C
ount
y __
____
____
____
____
__
Do
you
wor
k di
rect
ly w
ith y
outh
?
Y
es
N
o
Cod
e: 1
0089
Proj
ect N
ame:
Jun
ior M
aste
r Gar
dene
r
Yea
rs a
s a
4-H
Lea
der (
incl
udin
g th
is y
ear)
___
__
(
)(
)
Edu
catio
nal p
rogr
ams
of T
exas
Coo
pera
tive
Ext
ensi
on a
re o
pen
to a
ll pe
ople
with
out r
egar
d to
rac
e, c
olor
, sex
, dis
abili
ty, r
elig
ion,
age
or
natio
nal o
rigi
n.
____
____
_
____
____
____
____
____
D
ate
S
igna
ture
-
180 Registration 3 of 4
The
follo
win
g in
form
atio
n is
req
uest
ed in
sup
port
of t
he N
atio
nal J
MG
pro
gram
’s c
omm
itmen
t to
cont
inua
lly g
uara
ntee
the
safe
ty o
f the
mem
bers
dur
ing
4-H
par
tici-
patio
n.
Volu
ntee
r In
tere
st (
To b
e co
mpl
eted
by
volu
ntee
rs 1
8 ye
ars
or o
lder
)H
ave
you
prev
ious
ly s
erve
d as
a 4
-H v
olun
teer
?
Y
es
No
If y
es, w
here
? __
____
____
____
____
____
____
____
____
____
____
____
Cou
nty
___
____
____
____
____
____
____
Sta
te
And
how
man
y ye
ars?
___
____
____
____
__
Per
sona
l Inf
orm
atio
nD
o yo
u ha
ve a
cur
rent
/val
id d
rive
r’s
licen
se?
Y
es
No
I
f Yes
, dri
ver’
s lic
ense
# _
____
____
____
____
____
__D
o yo
u ha
ve a
utom
obile
liab
ility
insu
ranc
e?
Y
es
No
Ref
eren
ces
I cer
tify
that
the
stat
emen
ts m
ade
by m
e on
this
reg
istr
atio
n fo
rm a
re tr
ue, c
ompl
ete
and
corr
ect t
o th
e be
st o
f my
know
ledg
e an
d be
lief a
nd a
re m
ade
in g
ood
faith
. I
unde
rsta
nd th
at a
ny fa
lse
stat
emen
t mad
e he
rein
will
voi
d th
is r
egis
trat
ion
form
and
any
act
ions
bas
ed u
pon
it. I
auth
oriz
e th
e 4-
H J
MG
Pro
gram
or
any
of it
s co
m-
pone
nts
to m
ake
refe
renc
e ch
ecks
rel
atin
g to
my
volu
ntee
r se
rvic
e. I
unde
rsta
nd th
at th
is a
pplic
atio
n an
d al
l atta
chm
ents
are
the
prop
erty
of t
he T
exas
4-H
& Y
outh
D
evel
opm
ent P
rogr
am.
Hav
e yo
u ev
er b
een
conv
icte
d of
a v
iola
tion
of a
ny lo
cal,
stat
e or
fede
ral l
aw, o
ther
than
min
or tr
affi
c vi
olat
ions
? (T
his
incl
udes
a p
lea
of g
uilty
or
no
cont
est.)
Yes
No
If
YE
S, li
st a
ll co
nvic
tions
bel
ow, f
rom
the
olde
st to
the
mos
t rec
ent.
Dat
e of
Con
vict
ion
Mon
th a
nd Y
ear
Mar
k ap
prop
riat
e bo
x
M
isde
mea
nor
Fe
lony
Off
ense
(Do
not u
se a
bbre
viat
ions
)
1.
Nam
e__
____
____
____
____
____
____
___
Add
ress
____
____
____
____
____
____
____
City
____
____
____
____
_
ZIP
____
____
Tele
phon
e__
____
____
____
____
____
____
2.
Nam
e__
____
____
____
____
____
____
___
Add
ress
____
____
____
____
____
____
____
City
____
____
____
____
_
ZIP
____
____
Tele
phon
e__
____
____
____
____
____
____
3.
Nam
e__
____
____
____
____
____
____
___
Add
ress
____
____
____
____
____
____
____
City
____
____
____
____
_
Zip
____
____
Tele
phon
e__
____
____
____
____
____
____
Dat
eV
olun
teer
Sig
natu
re
-
Completion Form182
JMG
Jun
ior M
aste
r G
arde
ner C
ompl
etio
n Fo
rm(F
or C
ertif
icat
es -
Dup
licat
e as
Nee
ded)
Upo
n co
mpl
etio
n of
the
JMG
cur
ricu
lum
req
uire
men
ts, f
ill o
ut th
is f
orm
to r
eque
st J
MG
cer
tific
ates
for
you
r gr
oup
mem
bers
. Mai
l the
com
plet
ed f
orm
to J
unio
r
Mas
ter
Gar
dene
r Pr
ogra
m, 2
25 H
FSB
, 213
4 TA
MU
, Col
lege
Sta
tion,
Tex
as 7
7843
-213
4.
Dat
e: _
____
____
____
____
_ C
ount
y: _
____
____
____
____
____
____
____
____
J
MG
gro
up n
ame:
___
____
____
____
____
____
____
____
____
___
182
I cer
tify
that
JM
G g
roup
mem
bers
hav
e co
mpl
eted
all
the
requ
irem
ents
to re
ceiv
e th
e ab
ove
cert
ific
atio
n.
Teac
her/
lead
er n
ame:
____
____
____
____
____
____
____
____
___
Sign
atur
e: _
____
____
____
____
____
____
____
____
____
__ D
ate:
___
____
____
____
___
Cer
tific
ates
sho
uld
be m
aile
d to
the
follo
win
g ad
dres
s:__
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
____
__
Phon
e __
____
____
____
____
____
____
____
____
__(
)
City
Sta
te
Z
IP
®®
Nam
eA
ddre
ssC
ity/S
tate
/ZIP
CE
RT
IFIC
AT
ION
RE
QU
IRE
ME
NT
S C
OM
PLE
TE
D
JMG
Lev
el 1
(Che
ck b
elow
: al
l 8
chap
ters
mus
t be
com
plet
ed)
JMG
Gol
den
Ray
Ser
ies
(Lis
t Gol
den
Ray
Ser
ies
com
plet
ed b
elow
)
JMG
Lev
el 2
: Ope
ratio
n T
hist
le(L
ist m
odul
e co
mpl
eted
bel
ow:
i.e S
eeds
of D
espa
ir—
Pla
nt
Gro
wth
Dev
elop
men
t)
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