Application Heartwood Chapter Application Application to attend the next Training Session. Class size is limited. To assure space, please submit early. Date Date Format: MM slash DD slash YYYY Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code County of Residence*Home PhoneCell Phone*Email* Gender Male Female Prefer Not to Answer Optional InformationProviding this information helps the Texas Master Naturalist program acquire funding. Thank you.AgeUnder 1818-2425-3435-4445-5455-6465 or AbovePrefer Not to AnswerHighest level of education achievedHigh SchoolAssociate DegreeBachelor's DegreeGraduate or Professional DegreeSome CollegeOtherPrefer Not to AnswerMarital statusSingleMarriedDivorcedWidowedEthnic heritageCurrent occupationThe information you provide may be used to identify volunteers with specific skills for the state and/or chapter opportunities.If not currently employed, or retired, what was your previous occupation?Getting to know you...Please explain your interest in the Master Naturalist volunteer program.What are some organizations for which you have volunteered in the past two years? How many hours per month did you volunteer for each?Please indicate skills, professional training, or interests you could share as a Master Naturalist: Select All Education and/or Public Outreach (Speaking, nature guide, environmental educator, project development) Field Activities and/or Research (Monitoring/ surveys, plant/wildlife census, habitat restoration/planting, water quality testing, bird/butterfly counts, seed/plant collections, invasive species monitoring/removal) Administration (Chapter committee member/chair, newsletter editing/reporting, website updating, computer assistance, fundraising) Do you possess other skills or interests not specified above? Please be specific.Please specify how you wish your name to appear on your name tag and certification form.*Upon completion of initial certification requirements, you will receive a shirt with the TMN logo. Please select your size:*SmallMediumLargeXLargeXXLargeHow did you hear about us?NewspaperFacebookTwitterInstagramHeartwood BoothWord of mouthAcceptance for the Heartwood Training Session requires your commitment to attend all classes and field trips scheduled. To allow for illness or emergency, the schedule includes more than the minimum 40 hours of required training, however, you should plan to attend all classes.* By checking this box, I acknowledge that I am available to attend all classes and field trips and that I must attend a minimum of 40 hours of training, and will be required to complete at least 40 hours of approved volunteer service and 8 hours additional, approved advanced training to qualify for Certification as a Texas Master Naturalist within 15 months of the start of the Primary Training Session. I further understand that to maintain the status of Certified, I must complete a minimum of 40 hours of approved volunteer service and 8 hours of approved advanced training each calendar year after initial certification.Consent* In consideration of being accepted as a participant in the Texas Master Naturalist Volunteer Program of the Heartwood Chapter, I hereby release, discharge and agree to hold harmless the Program and its sponsoring state Agencies, their agents, employees, officers and successors for all personal injuries including death, and/or known and unknown damage to property caused by or arising out of activities performed under this program.Electronic Signature*UntitledFirst ChoiceSecond ChoiceThird Choice
