MISC-375 11-12-02
Specialist Assistance Confirmation
County	District
1. Specialist	2. Date and Time of Assistance
3. Location
4. Agent Name	5. Agent Title
6. Description of Assistance Expected
7. Approved	County Extension Agent – Staff Chair (Signature)	8. Date
Reply
9. Confirmation Received	Signature of Specialist	10. Date
11. Remarks
Instructions
County Office - Prepare, send original and 3 copies and submit to specialist
Specialist - Sign, keep one copy and distribute remaining copies to:
1. Requesting county - original
2. Appropriate District Director
3. State program leader or 1890 administrator