Download: IFYE Appliation .doc           Page 1 of  5 
Staple Recent Photo of Applicant
Here 
Write Applicant's Name and Phone number on back of photo.
(photo will not be returned.)
Attention Applicants:  Completed Application is DUE
to your 4-H Extension Educator by December 1st

Attention Extension Educators:  Send applications to the State 4-H Office
FAXES WILL NOT BE ACCEPTED
(Must be postmarked by December 8th )
Questions:  (301) 403-4248

MARYLAND 4-H INTERNATIONAL EXCHANGE
Participant Application - United Kingdom 2001

   Note:  Applicants must have passed their 17th birthday on January 1, 2001, and not have passed their 21st birthday on January 1, 2001 in order to be eligible to participate.

Print or type all information (illegible applications will be returned)
 
Name:  __________________ _______________________ ________________________
(First)
(Middle)
(Last)
Preferred First Name (if different from above):_________________ Daytime Phone: ___________
Gender:  _____ Age:  _____ Birthdate:  ___ /___ /___
                                                             month   day    year
Home Address (do not use a P.O. Box): 
City:  State:  Zip code: 
Mailing Address (if different from above): 
City:  State:  Zip code: 

Emergency Contact Information
 
Name of Person to be contacted in an Emergency:
Evening Phone:  (      )  Daytime Phone:  (      ) 

Parent/Guardian Information - (continued on page 2)
 
Mother's Name: Occupation: 
Work Address:  
City/State/Zip:  Daytime Phone:  (      ) 

 
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Information Sheet

2001 Maryland 4-H International exchange Program Application (revised 11/16/98)
Maryland Cooperative Extension programs are open to all citizens without regard to race, color , sex, disability, religion, age or national origin.