Applications are due October 15, 2012 Tests - Indiana 4-H - Purdue ...

NOTE:Applications are due October 15, 2012Tests: Will include questions on general judgingknowledge (conformation, etc.) Online with a due date of November 14, 2012. Paper test requires an additional $10 handling fee,and is due postmarked November 1, 2012 Only online tests will be accepted after November1, 2012.Seminar: Registration information is included along withthis application

INDIANA 4-H HORSE JUDGES’ APPLICATION FORMMail application with check made payable to Purdue University:$20 fee for online test or $30 for paper test to:4-H Horse Judges’ Application, Dr. Colleen Brady,615 W State, West Lafayette, IN 47907-2053Requirements for all judges for inclusion on the 2013 Indiana 4-H Horse and Pony Judges list: Applicant must be 21 years of age by January 1, 2013. Completed application with application fee of $20/$30 received by October 15, 2012.Completed Adult Behavioral Expectation FormCompleted test on the IN 4-H Horse and Pony rulebook with a score of at least 85% (information for testwill be sent after receipt of your application and ABE form).Paper tests due November 1; online tests due November 14.Attend the Multi-State Judges School at least once every three years. Registration information isenclosed. (if you did not attend in 2010 or 2011, you must attend in 2012)Check if you plan to attend seminar in person.Check if you are not planning to attend this year.Name: _______________________________________________________________________First Initial LastComplete address: _____________________________________________________________R.R., Street, Box No._____________________________________________________________City State ZipHome phone number: ___________________Alternate number: ________________________Email to receive test link (print legibly): ____________________________________________Check if you need a test mailed to you, instead of online. Fee must include additional $10 handling fee if thisbox is checked.Check if you need a rule book mailed to you.Previous applicants: What new national breed association judging cards have you added since your lastapplication?Applicants moving to B list: List contact information of your three references. You are required to request thatthey send a letter of reference to the State 4-H Office on your behalf. The letter must be received in the officeby November 14, 2012 for consideration for the B list for 2013.

New applicants: What national breed association judging cards do you currently hold? (please include copieswith application)Please check which of the following classes you feel qualified to judge:_________ Western_________ English_________ Dressage_________ Contesting_________ Draft_________ Horse Judging ContestsWere you on a 4-H/FFA or collegiate judging team?_____________________How many judging contests have you officiated in the last three years (includes assigning cuts andscoring oral reasons)?_________________________How many years have you been judging horse shows? _______________How many horse shows have you judged per year (on average) over that time?______________Please indicate which category on the list you wish to apply for. Experienced A- Renewal - Currently on the Experienced A list. Experienced A – Moving from B – must attend seminar.If you wish to move from the Experienced B to the Experienced A list, you must meet the following criteria: Must have a national breed card or 10 years experience (judging at least 30 shows over those 10 years) Must successfully complete an interview to move to the A category. Check here if you plan to interview on Friday afternoon (1pm-4pm, Nov. 16) in Ohio. Experienced B- Renewal – Currently on the Experienced B list. Experienced B- New applicants or moving from Novice – must attend seminar. Must complete judging at the Multi State Judges School with a minimum of 70%. Must have three reference letters from experienced horse people (at least one from a show manager.)The reference letter should contain information justifying the writer’s qualifications to write a letter ofreference for a 4-H Horse and Pony Judge. Reference letters must be received in the office by November14, 2012. Novice- Renewal – Currently on the Novice list. Novice – New – must attend seminar. Must attend the 2012 Multi State Judges School, and complete the judging portion of the conference.I hereby verify the information on this form to be complete and accurate and the $20.00/$30.00 annualapplication fee payable to Purdue University is enclosed. I also agree to abide by the Adult BehavioralExpectations, and understand that failure to do so may result in my removal from the Indiana 4-H Horse andPony Judges List.________________________________________Signature_______________________Date

Adult Behavioral Expectations4-H 785To Promote the Well-Being of Youth forFaculty, Extension Educators, Staff and Volunteers Who Workwith 4-H/Youth Development Programs in Indiana“Those who believe in and work with youthhave confidence in our future.”These Adult Behavioral Expectations give faculty, educators, staff and volunteers the opportunity to reaffirm theircommitment and dedication to the well-being of young people. When all faculty, educators, staff and volunteers sign acopy of this document, individuals are making a collective statement that youth in the 4-H/Youth Development Programare being treated with respect, dignity, and attention to individual needs. The faculty, educators, staff and volunteers whowork with the 4-H/Youth Development Program in Indiana are proud of the quality educational programs provided toyouth of this state and to their personal commitment to nurture the positive growth and development of youth.In my role as a 4-H/Youth Development Program faculty, educator, staff, or volunteer I will:• Respect, adhere to, and enforce the rules, policies, and guidelines established by the Purdue UniversityCooperative Extension Service including all laws related to child abuse and substance abuse.• Conduct myself in a courteous, respectful manner, exhibit good sportsmanship, and demonstratereasonable conflict management skills.• Be truthful and forthright when representing the 4-H/Youth Development Program.• Under no circumstances allow, consume, or be under the influence of alcohol or illegal drugs at4-H/Youth Development Program events or activities.• Recognize that verbal or physical abuse, failure to comply with equal opportunity and anti-discriminationlaws, or committing criminal acts are not acceptable practices in 4-H/Youth Development Programs.• Accept my responsibility to represent 4-H/Youth Development Programs with dignity and pride by beinga positive role model for youth.• Accept supervision and support from salaried Extension staff or designated management volunteers.• Participate in orientation and training, which includes youth protection standards, sponsored by thePurdue Cooperative Extension Service.• Operate machinery, vehicles, and other equipment in a safe and responsible manner when working withyouth participating in 4-H/Youth Development Programs.• Treat animals in a humane manner and teach program participants appropriate animal care andmanagement.• Use technology in an appropriate manner that reflects the best practices in youth development.• Accept my responsibility to promote and support the 4-H/Youth Development Program in order todevelop an effective county, state, and national program.

I have been given the opportunity to review these expectations and the opportunity to ask questions, and any questionshave been answered to my satisfaction. By signing below, I acknowledge that I have read and agree to abide by thebehavioral expectations in this document. I understand that my failure to comply with these expectations may result indisciplinary action or termination as a faculty member, educator, staff, or volunteer of the Indiana 4-H/YouthDevelopment Program._____________________________________Print Name__________________________________Date_____________________________________Signature__________________________________Date_____________________________________Educator Signature__________________________________DateA signed copy of the Adult Behavioral Expectations for each faculty, educator, staff, and volunteer in 4-H/Youth Extension programswill be on file in the respective administrative office after January 1, 1992.These Behavioral Expectations and related policies have been developed by faculty, educators, staff, and volunteers to strengthen thework of those who believe in the 4-H/Youth Development Program.It is the policy of the Purdue University Cooperative Extension Service, Charles Hibberd, Director, that all persons shall have equal opportunity and access to theprograms and facilities without regard to race, color, sex, religion, national origin, age, marital status, parental status, sexual orientation, or disability.Purdue University is an Affirmative Action employer. This material may be available in alternative formats.1-888-EXT-INFOhttp://www.agcom.purdue.edu/AgCom/Pubs/menu.htm

784 ConsentV. CONSENT FOR 4-H/YOUTH DEVELOPMENT VOLUNTEER BACKGROUND CHECK:Date of Birth ________________________Month Day YearSocial Security Number ______ - ______ - _______Alias/Maiden Name ________________________PLEASE NOTE: A criminal record will not necessarily disqualify an applicant. A criminal record will beconsidered as it relates to specifics of the position.I certify that the above information is correct. I authorize the contact of the references listed above. I understandbackground checks will be conducted. I authorize the Purdue University Cooperative Extension Service tocontact the Indiana Criminal Justice Institute to conduct a search of the Sex and Violent Offender Registry torelease any information on the Registry to the Purdue University Cooperative Extension Service. I understandthe misrepresentation or omission of facts requested is just cause for non-appointment as a Purdue UniversityCooperative Extension Service youth program volunteer.If accepted as a volunteer, I agree to respect, adhere to, and enforce the rules, policies, and guidelinesestablished by the Purdue University Cooperative Extension Service including all laws related to child abuseand substance abuse. I recognize that the 4-H/Youth Development Program is part of the Purdue CooperativeExtension Service, in which the United States Department of Agriculture, Purdue University, and all Indianacounties share. As a volunteer, I am committing to involve individuals regardless of race, color, sex, religion,national origin, age, or disability in educational experiences in cooperation with other Extension volunteers andExtension personnel..Volunteer signature: _____________________________________________________________Date: ____________________________Contact us if you have any questions or wish further information. Thank you!