Regional 4-H PYD Champion Network Membership Application (Rolling Application)

Regional 4-H PYD Champion Network Membership Application

The Regional 4-H PYD Champion Network is made up of two 4-H professionals from Land-Grant Universities (LGUs) across the five Extension Regions. Champions are chosen through a competitive application process for a two or three year term. Champions will work together in their Extension regions under the leadership of a national facilitator to advance the consistent use of the 4-H Thriving Model as the theory of positive youth development for 4-H. Regional networks will focus primarily on capacity building efforts for 4-H professionals and volunteers, with a special focus on consistent orientation for onboarding new 4-H professionals.

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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 network?

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 a4-H Thriving Champion.

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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

I do not hold a professional 4-H 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	Desire to establish a consistent model of PYD across the 4-H system Yes	Desire to establish a consistent model of PYD across the 4-H system 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 (some initial terms will be two-years to stagger turn over)	Commitment to a three-year term (some initial terms will be two-years to stagger turn over) Yes	Commitment to a three-year term (some initial terms will be two-years to stagger turn over) No
Commitment to active participation and leadership in regional network activities, including monthly virtual gatherings and at least one sub-group effort	Commitment to active participation and leadership in regional network activities, including monthly virtual gatherings and at least one sub-group effort Yes	Commitment to active participation and leadership in regional network activities, including monthly virtual gatherings and at least one sub-group effort 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
Travel support to attend one in-person session annually (in conjunction with the NAE4-HYDP Conference)	Travel support to attend one in-person session annually (in conjunction with the NAE4-HYDP Conference) Yes	Travel support to attend one in-person session annually (in conjunction with the NAE4-HYDP Conference) No