Applicant Signature Date University of Alaska Fairbanks Cooperative Extension Service / /
Organization
Alaska Fairbanks Cooperative Extension Service / FBI NCIC / Federal Bureau of Investigation / Department of Justice / FBI National Crime Information Center / Federal Trade Commission / Bureau of Investigation Criminal Justice Information Services / University of Alaska / Applicant Signature Date University / / /
For
District
Office
Use
Only
District
Name:
________________
PROOF
OF
PAYMENT:
Alaska 4-H Volunteer Service