Michigan State University Extension

4-H Youth Development

 

 

4-H Global & Cultural Education

Important Message to Michigan 4-H Staff on 4-H International Exchange Forms

Dear Colleagues,

All Labo, FLEX and Finland forms have been changed. Each of the new forms will have a space at the top for where the state is identified. This will clarify to delegates that they are participating with "[STATE'S] Program" and are covered by that Land Grant University's liability insurance.

The essential forms needed for staff and volunteer coordinators to use for the 2009 summer exchanges and for the 2009-2010 school year are listed below. The Interview and Reference forms are general and can be used for prospective host families for summer inbound or year-long inbound host family applicants. Year long host families will need to fill out the Criminal History Check (Disclosure Form) form listed here not the state form we have used in the past.

Most of the forms linked below are in Microsoft Word format (unless noted as "PDF"). If your Web browser does not open the Word documents directly upon clicking the link, download the files by doing the following:

  1. While holding the curser over the link you wish to open, right click. You will get a "fly out" menu.
  2. Select the option "Save Target As" and save the file to your computer (note the location).
  3. Start Word and open the file from the file location you downloaded it to.

Documents noted as "PDF format" (Portable Document Format) require the free Adobe Acrobat Reader in order to view or print. If you don't have the Acrobat Reader, you can download it from Adobe at http://www.adobe.com/products/acrobat/readstep.html.

2009 Forms and Information for 4-H International Exchanges

Poland and Belize 4-H Exchange Program Forms and Information

Below are the forms related to the 2009 4-H Exchanges with Poland and Belize. Belize is a three-week hosting experience and a three-week travel experience. Please read the brochure for details.

Belize

Belize Brochure 2009 BelizeBrochure09.doc (MS Word format)

Please send applications for the Summer Inbound Belize exchange to:

Pat Dignum, Extension Educator
4-H Youth Development
Montcalm County MSU Extension
P.O. Box 308
211 West Main
Stanton, MI 48888  
Phone: 989-831-7500
Fax: 989-831-7515
Email:  dignum@msu.edu  

Summer Inbound Belize 2009

Belize Host Family Application 2009Poland-Belize-Host-FamilyApplication.doc (MS Word format)
Belize Host Family Reference 2009Poland-BelizeHostFamilyReference.doc (MS Word format)
Belize Host Family Interview Report 2009Poland-Belize-Host-Family-Interview-Report.doc (MS Word format)
Criminal History Record Check MSUExtCriminalHistoryCheckForm.doc (MS Word format)

Please send applications for the Summer Outbound Belize exchange to:

Janis K. Brinn, Extension Educator
4-H Youth Development
Allegan County MSU Extension
Human Services Building
3255 122nd Avenue, Suite 101
Allegan, MI 49010-9511

Phone: 269-673-0370 Ext. 2555 (21)
Fax: 269-673-7005
Email:  brinn@msu.edu

Summer Outbound Belize 2009

Belize Participant Travel Application 2009Poland-Belize-4-H-Participant-Travel-App.doc (MS Word format)
Belize Participant Agreement Belize-Participant-Agreement-09.doc (MS Word format)
Belize Parental Release to Travel Poland-Belize-Parental-Travel-Release.doc (MS Word format)

Poland

Please send host family applications for the Poland exchange to:

Bethany Prykucki
Otsego County MSU Extension
800 Livingston Blvd., Suite 4A-2
Gaylord, Michigan 49735-8321
E-mail: prykucki@msu.edu
Phone: 989-731-0275
Fax: 989-731-0744

Poland Press Release PolandPressRelease.doc (MS Word format)
Poland Brochure 09 PolandBrochure09.pdf (PDF format)

Poland Inbound 2009

Poland Host Family Application 2009Poland-Belize-Host-FamilyApplication.doc (MS Word format)
Poland Host Family Reference 2009Poland-BelizeHostFamilyReference.doc (MS Word format)
Poland Host Family Interview Report 2009Poland-Belize-Host-Family-Interview-Report.doc (MS Word format)
Criminal History Record Check MSUExtCriminalHistoryCheckForm.doc (MS Word format)

 


4-H Exchange Program Forms and Information for All Other Countries

2009 Summer Inbound

Please send host family applications for the JAPANESE summer inbound exchange to:

Larry Johnson
4730 Charleston Court
Holland, Michigan 49423
E-mail: johns153@msu.edu
Phone: 616-396-1426
Fax: 269-673-7005

Summer Inbound Checklist - Japan SummerInboundChecklist-Japan.doc (MS Word format)
Summer Inbound Checklist - Finland SummerInboundChecklist-Finland.doc (MS Word format)
2009 Host Family Application and Picture 2009HostFamilyApp.doc (MS Word format)
Confidential Host Family Reference HostFamilyReference.doc (MS Word format)
Host Family "In-Home" Interview Report HostFamilyInterview.doc (MS Word format)
Host Family "In-Home" Interview Guidelines HostFamilyGuidelines.doc (MS Word format)
Host Family Description HostFamilyDescription.doc (MS Word format)
Criminal History Record Check MSUExtCriminalHistoryCheckForm.doc (MS Word format)

2009 Summer Outbound (Japan only) — Delegates

Please send host family applications for the Japanese summer outbound exchange to:

Vera Wiltse
Isabella County MSU Extension
200 N. Main Street
Mount Pleasant, Michigan 48858
E-mail: wiltsev@msu.edu
Phone: 989-772-0911 Ext. 302
Fax: 989-773-1622

Japan Promotional Materials 2008 2009JapanOBPromo.doc (MS Word format)
Checklist 2009OBChecklist.doc (MS Word format)
2009 Outbound Participant Application 2009OutboundParticipantApplication.doc (MS Word format)
Outbound Participant Interview Form OutboundParticipantInterview.doc (MS Word format)
Code of Conduct CodeOfConduct.doc (MS Word format)
Medical Form - Youth MedicalForm(Japan).doc (MS Word format)
Participant Insurance Agreement ParticipantInsuranceAgreement.doc (MS Word format)
Medical Release Form MedicalReleaseForm(Japan).doc (MS Word format)
Mandatory Cultural Project MandatoryCulturalProject.doc (MS Word format)
Confidential Participant Reference ConfidentialParticipantReference.doc (MS Word format)

2009 Summer Outbound (Australia, Finland, Costa Rica) — Delegates

Australia Promotional Materials 2009 2009AustraliaOBPromo.doc (MS Word format)
Finland Promotional Materials 2009 2009FinlandOBPromo.doc (MS Word format)
Checklist 2009OBChecklist.doc (MS Word format)
2009 Outbound Participant Application 2009OutboundParticipantApplication.doc (MS Word format)
Participant Interview Form OutboundParticipantInterview.doc (MS Word format)
Code of Conduct CodeOfConduct.doc (MS Word format)
Medical Form MedicalForm(non-Japan).doc (MS Word format)
Participant Insurance Agreement ParticipantInsuranceAgreement.doc (MS Word format)
Medical Release Form MedicalReleaseForm(non-Japan).doc (MS Word format)
Mandatory Cultural Project MandatoryCulturalProject.doc (MS Word format)
Confidential Participant Reference ConfidentialParticipantReference.doc (MS Word format)

2009 Summer Outbound (Australia, Finland, Costa Rica) — Chaperones

Chaperone Checklist ChecklistChaperon.doc (MS Word format)
2009 Outbound Chaperone Application 2009ChaperoneApplication.doc (MS Word format)
Chaperone Agreement ChaperoneAgreement.doc (MS Word format)
Criminal Background Check (CBC) Disclosure Form ChaperoneDisclosure.doc (MS Word format)
Chaperone Interview Form ChaperoneInterviewForm.doc (MS Word format)
Chaperone Medical Form MedicalForm(Non-Japan)Chaperone.doc (MS Word format)
Chaperone Insurance Agreement ChaperoneInsuranceAgreement.doc (MS Word format)
Confidential Chaperone Reference ConfidentialChaperoneReference.doc (MS Word format)

2009-10 FLEX

FLEX Checklist FLEXChecklist.doc (MS Word format)
2009 Host Family Application Form HostFamilyApp.doc (MS Word format)
Host Family "In-Home" Interview Report HostFamilyInterview.doc (MS Word format)
Confidential Host Family Reference HostFamilyReference.doc (MS Word format)
Criminal Background Check (CBC) Disclosure Form FLEXDisclosure.doc (MS Word format)
High School Acceptance Form HSAcceptance.doc (MS Word format)
Travel Release Form TravelRelease.doc (MS Word format)

If you have any questions, please call or email me.

Renée Applegate
4-H International Exchange Coordinator
4-H Youth Development
Michigan State University
160 Agriculture Hall
East Lansing, MI 48824-1039
USA

Phone: 517-432-7624
Fax: 517-353-4846
Email: applega1@msu.edu


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Last Updated: March 12, 2009
Last Reviewed: January 9, 2009