North Carolina 4-H International Exchange
2011 Forms and Information

Resources for County Extension Agents (Coming Soon)

• In-home Interview/Visit Guidelines
• In-home Interview/Visit Report Form
• Year Long Documentation of Contact Form
• Host Family Checklist for Working with Month Long Host Families
• Year Long FLEX Checklist for Working with Year Long Host Families

Summer Inbound Host Family Information

• 2011 Host Family Application and Picture
• Confidential Host Family Reference
• Host Family Disclosure Form
• Additional Page for Host Family Application who wish to Host students from all Countries except Japan
• Flyer on Hosting a Japanese student

Summer Outbound - Delegates to Japan
(All documents below should be turned in to Carolyn Langley, State 4-H International Exchange Coordinator By January 17, 2011, 112 West Walker Ave., Asheboro, NC 27203)

• 2011 Outbound Participant Application
• Code of Conduct
• Medical Form - Youth
• Participant Insurance Agreement
• Medical Release Form
• Culture Project
• Confidential Participant Reference
• Photo Release
• Japan travel grant for previous host families

Summer Outbound- Delegates to Australia, Costa Rica, and Finland
(All documents below should be turned in to Carolyn Langley, State 4-H International Exchange Coordinator By January 17, 2011, 112 West Walker Ave., Asheboro, NC 27203)

• 2011 Outbound Participant Application
• Code of Conduct
• Medical Form - Youth
• Participant Insurance Agreement
• Culture Project
• Confidential Participant Reference
• Photo Release

Year Long High School Host Family Information Program
(TO BE DETERMINED IN JANUARY 2011)

• 2011 Host Family Application
• Confidential Host Family Reference
• Criminal Background Check Disclosure Form
• High School Acceptance Form

North Carolina Scholarships- NC 4-H has limited scholarship money to offer ACTIVE 4-H members in at least $250.00 increments dependent on the number of outbound 4-H members. Recipients are required to write an essay which indicates what they will doupon returning to share their experience with others and how they intend to promote the NC 4-H international Exchange program in the future. A scapebook with pictures and an essay of what was learned is due by September 15 following their trip

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