2022 S4-H秋/冬季筆友計畫報名表
交個國際朋友吧!2022 美國州際筆友交換計畫開始報名囉!透過電子信件和美國的青年夥伴互動,培養孩子具有國際視野,並從中獲得6Cs之關鍵能力、自信、品格、連結、關懷及貢獻,學習即在生活,參與者將會:
○提升英文能力。
○學習異國文化。
○更好為將來到國外交流做準備。

活動資訊:
一、活動時間:111年9月至11月。
二、活動費用:新台幣1,200元/人 (請於8/12(五)前繳款完畢,繳款後請至表單填寫https://s.fourh.org.tw/kypr6)。
三、報名資格:
1.9-18歲之青少年。
2.有基本英文會話及書寫能力。
3.能提供有效的電子郵件網址。
4.能每月和筆友通信數次。
5.完成繳費者。(繳款後請至表單填寫https://s.fourh.org.tw/kypr6)

匯款資訊:
國泰世華古亭分行帳號:030501157518
銀行代碼:013
戶名:中華民國四健會協會

2022冬季就和美國青年一起交流吧!
請填寫下方表單進行註冊,謝謝。

聯絡人:中華民國四健會協會
賴韋中 專員 02-2362-6021#14 da70168@fourh.org.tw
賀秀錚 助理 02-23626021 #23 st96108@gmail.com
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1. Please enter your primary email address. *
 A valid email is required for program participation. Please double-check that the email address and confirmed email address match.
2.Please enter a secondary email address. *
Please make sure the secondary email address is not the same as the primary email.
3.Please enter your first name. *
請填寫你的名並使用羅馬拼音,將用於英文證書
4.Please enter your last(family) name. *
請填寫你的姓氏並使用羅馬拼音,將用於英文證書
5.Please select your age. *
6.Please enter your date of birth. *
YYYY/MM/DD(西元年/月/日)
MM
/
DD
/
YYYY
7.Please select your gender. *
Non-binary genders are acceptable as inputs.
8.Please enter any additional contact information you would like to share with your pen pal. (OPTIONAL)
Mailing Address, Phone Number, App Name + App ID, Instagram, Facebook Other.
9.Are you a member of 4-H in your country? (being a member is not a requirement to participate) *
10.Have you participated in any States' 4-H exchanges in the past? Please select all that apply. *
Required
11.Please select 3 hobbies/interests that you most identify with. *
Required
12.Additional notes/requests may be listed here. (OPTIONAL)
13.By signing up, I agree to communicate (at least) four times with my pen pal match during the program period. We may communicate as many times as both parties feel comfortable with. *
14.中文姓名 *
15.單位/學校 *
臺中市大甲區農會/國立興大附農
16.家長姓名/緊急聯絡人 *
17.家長聯絡電話/緊急聯絡人電話 *
18.我同意繳交新台幣1,200元作為活動配合款項。 *
19.收據抬頭 *
ex. 高雄地區農會(請事先與四健指導員確認是否由農會補助)
20.收據統編 *
ex.03716367
21.郵遞區號 *
僅作為寄發收據用途,請填寫3+3碼(ex.100032)可至以下網站查詢https://www.post.gov.tw/post/internet/SearchZone/index.jsp?ID=130107
22.收信地址 *
僅作為寄發收據用途 (ex.台北市中正區辛亥路一段37巷1號)
備註
匯款資訊
銀行匯款
030501157518
國泰世華 古亭分行
銀行代碼:013
戶名:中華民國四健會協會
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