HEART OF TEXAS CHAPTER
TEXAS MASTER NATURALIST™ PROGRAM
This program is a collaborative effort between the Texas AgriLife Extension Service
and Texas Parks & Wildlife Department.
Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability,
religion, age or national origin.
Application to attend the 2015 Training Session
Tuition Fee for training session is $150, non-refundable after August 25th.
Please make checks payable to TMN Heart of Texas Chapter.
Orientation is August 25, 2015, 6-7:30 pm.
Last date to submit application and fee is July 31, 2015.
Class size is limited. To assure a spot, submit early. Check website for details.
txmn.org/heartoftexas/
Name:
Preferred Name:
(Preferred Name as you wish it to appear on your certificate if different)
Gender:
Mailing Address:
Street
City
County
Zip Code
Telephone:
Email Address:
Occupation/Employer: _
If not employed what was your former occupation?
Emergency contact name & phone number
Complete ALL PAGES of this form and mail or deliver them along with $150 tuition fee or deposit of $75.00 (checks
made out to TMN Heart of Texas Chapter) to:
TMN HEART OF TEXAS CHAPTER
ATTN: Janet Wallace
Texas AgriLife Extension Service
420 N. 6th Street
Waco, TX 76701-1315
Phone: (254) 757-5180
Initial EACH item:
I have reviewed the Training Schedule provided and am available to attend all classes and field
studies.
I understand I will be required to complete at least 40 hours of Volunteer Service and 8 hours of
Advanced Training within 12 months of the start of classes to become a Certified Texas Master Naturalist and a
member of the Heart of Texas Chapter.
I understand that to maintain Certified Status as an active member of the Texas Master
Naturalist Program, I must complete at least 40 hours of Volunteer Service and 8 hours of Advanced Training
each year.
I understand that the Master Naturalist learning sessions will be held outdoors. I also understand
that the training will include outdoor activities, will be physically demanding at times and will include hiking
and the possibility of inclement weather. I agree to participate under these circumstances. I further understand
that the sponsors of the program will make reasonable accommodations for persons with disabilities when
reasonable accommodations can be made.
Briefly describe why you are interested in the Texas Master Naturalist volunteer program.
Indicate any organizations of which you are a member, or have volunteered time during the last two years,
and indicate the average number of hours you have volunteered for each organization on a monthly basis.
Please indicate all skills, professional training, or interests which you would care to share as a Texas Master
Naturalist (check all that apply):
Educational and/or Public Information, such as Speaking, Nature Guide, Children’s Activities, Project
Development
Field Activities and/or Monitoring/Surveys, such as Plant/Wildlife Census, Habitat
Restoration/Planting, Water Quality Testing, Bird/Butterfly Counts, Seed/Plant Collection
Administrative Assistance, such as serving on Committees (Membership, Volunteer Service, Advanced
Training), Newsletter, Database/Computer Assistance, Fundraising Activities
Other (be specific)
I understand that in exchange for the training made possible through the Heart of Texas Chapter of the Texas
Master Naturalist program, I will volunteer at least 40 hours of my time toward approved projects and complete
8 hours of advanced training within one year. I understand that I will become a Certified Texas Master
Naturalist when I complete both the training and the volunteer work. I also understand that to maintain an active
status, I must complete 8 hours of advanced training and 40 hours of volunteer service each year thereafter.
Signature
Date
(Please sign after printing)
TEXAS MASTER NATURALIST
VOLUNTEER POLICY
(Initials)
(Initials)
(Initials)
(Initials)
(Initials)
(Initials)
(Initials)
(Initials)
I understand that I must attend a minimum of 40 hours of Texas Master Naturalist training.
One class may be missed but that subject content must be made-up within a year. Once the class
has been completed then I will be eligible for certification as a Texas Master Naturalist.
I understand that I must complete the training, a minimum 40 hours of volunteer service
and at least 8 hours of advanced training to be certified as a Texas Master Naturalist. The
volunteer service and advanced training must be completed within one year after completion of
the initial 40-hour training. To retain my certification as a Texas Master Naturalist, I must
annually complete a minimum of 40 hours of volunteer service and 8 hours of advanced training.
I understand that the volunteer service will be done only on projects approved by the Texas
AgriLife Extension Service County Agent and/or a participating Texas Parks and Wildlife
employee, and /or the Chapter Volunteer Service Committee (or equivalent). Advanced training
outside the chapter must also be pre-approved by the Chapter Curriculum Committee (or
equivalent).
I understand and acknowledge that the local chapter in which I am receiving training under
may have training, advanced training and volunteer service requirements exceeding that of that
state established minimum requirements and agree to uphold their locally set standards.
I agree to faithfully fulfil my obligation as a volunteer participant of the Texas Master
Naturalist Program.
I agree to present a positive public image that speaks well of the Texas Master Naturalist
Program and its statewide sponsors of the Texas AgriLife Extension Service and the Texas
Parks & Wildlife Department.
I agree to actively participate as a team member with other individuals of the Texas Master
Naturalist Program.
I understand that in consideration of being accepted as a participant in the Texas Master
Naturalistvolunteer program ("program") sponsored by the Texas Parks & Wildlife
Department and the Texas AgriLife Extension Service, I hereby release, discharge, and agree to
hold harmless the program and its sponsoring state agencies, their agents, employees, officers
and successors, from and against all liability, claims demands, and judgments which the
undersigned, may have, or which my heirs, executors, administrators or assigns may have or
claim to have against the program and sponsoring state agencies, their successors, employees, or
officers for all personal injuries (including death), known and unknown or damage to property
caused by or arising out of activities performed under the Texas Master Naturalist Program.
-OVER-
Yes, I will be able to comply with the requirements listed above.
(Initials)
(Initials)
No, I cannot comply with the above policies and understand that I cannot be accepted nor
certified as a Texas Master Naturalist.
Volunteer Pledge:
I understand and agree to uphold the above statements of the Texas Master NaturalistProgram:
Signature
Date
Name (please print)
Chapter Affiliation
Heart of Texas Chapter
Mailing Address 1
Mailing Address 2
City
State TX Zip Code
Primary Phone:
Email Address
Name, Relationship & Phone Number to contact in case of emergency (please print):
Name:
Relationship:
Phone Number(s):
Name:
Relationship:
Phone Number(s):
This program is intended to serve people of all ages regardless of socioeconomic level, race, color, sex religion, disability or
national origin. We seek to provide reasonable accommodations for all persons with disabilities. Please advise us as soon as
possible of auxiliary aid or service that you require.