United States Department of Agriculture
United States Department of Agriculture - Animal and Plant Health lnspection Service cnecr<rct ) Attachment s, pe School,*" ffi" AgDiscoverynrooram ffi" SubmitApplication i Stuoent lnformation I I I * Firct Name * Middle lnitial * Last Name I Ij tl * Mobile/CellPhone Number * Gender Qtvtate QFemale Qerefer Not To Answer @tner * Cunent n * Email Address Home Phone Number * Date of Birth I Home Address * Address * City * State * Zip Code r---l United States Department of Agriculture r Animal and Plant Health lnspection Service Cnecr<rist ) Attachment school ,*" ffi AgDiscovery erosram @ submit Application ParenUGuardian lnformation * First Name This value is required * Email Address * last Name This value is required This value is required * Mobile/Cell Phone Number This value is required Home Phone Number i I t*- I l II I I I I i I ! …
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United States Department of Agriculture - Animal and Plant Health lnspection Service cnecr<rct ) Attachment s, pe School,*" ffi" AgDiscoverynrooram ffi" SubmitApplication i Stuoent lnformation I I I * Firct Name * Middle lnitial * Last Name I Ij tl * Mobile/CellPhone Number * Gender Qtvtate QFemale Qerefer Not To Answer @tner * Cunent n * Email Address Home Phone Number * Date of Birth I Home Address * Address * City * State * Zip Code r---l United States Department of Agriculture r Animal and Plant Health lnspection Service Cnecr<rist ) Attachment school ,*" ffi AgDiscovery erosram @ submit Application ParenUGuardian lnformation * First Name This value is required * Email Address * last Name This value is required This value is required * Mobile/Cell Phone Number This value is required Home Phone Number i I t*- I l II I I I I i I ! Emergency Contact lnformation * First Name This value is required Home Phone Number * Last Nanre This value is required * Mobile/Cell Phone Number This value is required | *"-ll ^r"" I cnecmist ) nttacnments ) Student lnfo > ParenVGuardian lnfo School lnfo > AsDiscovery ,r*rar @ Submit Application i*- I I I I I i t i I School lnformation * SchoolName Thisvalue is required * CIty Thisvalue is required * State Thisvalue is required * Zip Gode This value is required * Cunent Grade Onn Grade Qetn Grade Ogtn Grade Qtotn Grade Omn Grade Otan Grade This value is required School Graduation Year value is required * High [] This i I *_J | 8""-l | -*l United States Department of Agriculture E Animal and Plant Health lnspection Service cnecr<list h Aitachment" h Student'*" F Parent/Guaraian rnto p School'*" P AsDiscoveryn.or"* ) SubmitApplication * Select the AgDiscovery Prcgram you wish to apply for below PLEASE ONLY SELECT ONE. QAtcorn State University - June 18-28, 2019 - Currently in grades 7-10 QCdifornia State University, Fresno - June 9-22,2019 - Currently in grades 9-11 @oppin State University - July 7-19,2019 - Currently in grades 8-11 QDehware State University - July 7-2O,2019 - Currently in grades 8-11 QFbridaA&M University - June 9-22,2019 - Currently in grades 8-11 Qtowa State University - July 14-27,2019 - Currently in grades 9-11 QKentucky State University - June 9-22,2A19 - Currently in grades 7-11 Qlincoln University - Missouri - JulyT-20,2019 - Currently in grades 7-11 Qruortfr Carolina State University - June 17-28,2019 - Currently in grades 9-11 QPrairie View A&M University - June 17-28,2019 - Currently in grades 9-11 QPurdue University - JulyT-2O,2019 - Currently in grades 9-11 QTuskegee University - June 8-22,2019 - Currently in grades 9-11 QUniversity of Arizona - June 17-27,2019 - Currently in grades 9-11 QUniversity of Arkansas at Pine Bluff - June 8-21, 2019 - Currently in grades 8-11 QUniversity of Hawaiiat Minoa - JulyT-2O,2019 - Currently in grades 9-11 QUniversity of lllinois at Urbana-Champaign - July 7-August 3, 2019 - Curently in grades 9-11 QUniversity of Maryland College Park - JulyT-26,2019 - Currently in grades 9-11 QUniversity of Maryland Eastern Shore - JulyT-2O,2O19 - Currently in grades 8-11 QUniversity of the Virgin lslands - July 28 -August 10, 2019 - Gurrently in grades 7-11 QVirginia State University - June 9-22,2019 - Currently in grades 9-11 This value is required How did you find out about AgDiscovery? lnSOi""overy Website United States Department of Agriculture r Animal and Plant Health lnspection Service cnecr<rist ) Attachmentr F Student,*" }> ParenVGuaroian lnto p School '*" ) AoDiscoverv e.erarn ), Submit Aoolication lf you are selected to pafticipate in the AgDiscovery Program, you must provide the following documentation: o Proof of age o Proof of school enrollment . Current high schooltranscript (for University of Maryland College Park applicants only) Please DO NOT send those documents with your application. IMPORTANT NOTE: Applicants selected to attend the AgDiscovery program are required to attend the program in its entirety. Please do not apply if you have any obligations (i.e., vacation plans, summer camps, etc.)that will prevent you from attending the entire AgDiscovery program, which includes weekends, and opening and closing day activities. Terms of Acceptance and Signature l, the applicant for AgDiscovery, warrant the truthfulness of the information provided in this application. * Electronic Signature This value is required Pleasetype your First and Last Name I I understand that checking this box constitutes a legal signaturc and that once this application is submitted it cannot be modified.