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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.
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A valid email is required for program participation. Please double-check that the email address and confirmed email address match.
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2.Please enter a secondary email address.
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Please make sure the secondary email address is not the same as the primary email.
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3.Please enter your first name.
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請填寫你的名並使用羅馬拼音,將用於英文證書
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4.Please enter your last(family) name.
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請填寫你的姓氏並使用羅馬拼音,將用於英文證書
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5.Please select your age.
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6.Please enter your date of birth.
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7.Please select your gender.
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Non-binary genders are acceptable as inputs.
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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.
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9.Are you a member of 4-H in your country? (being a member is not a requirement to participate)
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10.Have you participated in any States' 4-H exchanges in the past? Please select all that apply.
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1) Hosted a delegate or chaperone through a States' 4-H program
2) Traveled to the U.S. through a States' 4-H program
3) Participated in prior States' 4-H Pen Pal Programs
4) None of the above apply to me
5) Other (Please specify)
Other:
Required
11.Please select 3 hobbies/interests that you most identify with.
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Outdoors & Nature
Sports
Video games & Computers
Food & Cooking
Animals
Music
Arts & Crafts
Movies & TV
Anime & Comics
Shopping
Reading
Other:
Required
12.Additional notes/requests may be listed here. (OPTIONAL)
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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.
*
Agree
14.中文姓名
*
Your answer
15.單位/學校
*
臺中市大甲區農會/國立興大附農
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16.家長姓名/緊急聯絡人
*
Your answer
17.家長聯絡電話/緊急聯絡人電話
*
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18.我同意繳交新台幣1,200元作為活動配合款項。
*
同意
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)
無
Other:
20.收據統編
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ex.03716367
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21.郵遞區號
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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
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22.收信地址
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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)
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備註
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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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