Mentoring a URI Energy Fellow January 17, 2018 School Name(Required)School Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country School Phone(Required)Name of Principal(Required) First Last Email(Required) Phone(Required)Primary Garden Contact(Required) First Last Email(Required) Phone(Required)Title / Role(Required)6. Are any of your garden contact(s) interested in taking the URIMGP Core Training?If so, they will receive automatic acceptance if they menton that they are affiliated with a school garden when asked about affiliation with partner organizations in the application. https://web.uri.edu/mastergardener/training/ First Choice Second Choice Third Choice 7. What phase is your school garden in currently? Check ALL that apply.(Required) We have the support of the school principal and/or superintendent for the garden. We are in the planning phase for a NEW garden. We have an existing garden in the ground. We are expanding our garden. We have one garden champion and are looking to expand. We have a team of people RECRUITED to help the garden. We have a team of people ACTIVELY supporting the garden. We have a funding plan / grant We have a summer maintenance plan. We have a water source easily available. 8. Briefly describe the reason for requesting partnership with a URI School Garden Mentor.(Required)Subject to availability, URI Cooperative Extension will provide school with a team of “School Garden Mentors” (SGMs), certified URI Master Gardener volunteers who have completed additional school garden training. SGMs have undergone state BCI checks and will follow school volunteer procedures; SGMs serve as resources, advocates and educators to help schools achieve their garden goals as described in detail on the SGM PROGRAM OFFERINGS TO SCHOOLS; SGMs are conduits to resources and services provided by the URI Cooperative Extension, including but not limited to: gardening technical guidance, site assessment, free seeds and seedlings, full soil testing and the URI Gardening Hotline; SGMs are not responsible for weeding or watering school gardens, however they will work with school to develop a maintenance plan and lead workdays with school participation.Consent Submission of this form indicates your interest in the URI School Garden Initiative, and the services available to approved schools. This form must be approved by the school principal.Name of Principal(Required) First Last Date(Required) MM slash DD slash YYYY Δ
