ASSOCIATE EXTENSION & CHANGE OF FIELD APPLICATION TWO MONTH MINIMUM "*" indicates required fields NAME* F L EMAIL* My project/account #* TODAY'S DATE* Month Day Year APPOINTMENT END DATE* Month Day Year My Appointment has expired. Yes REQUEST TYPE* Extension Only Extension Combo (with Change of Field) PERMANENT NORTH AMERICA MAILING ADDRESS*This address is used for sending legal documents such as tax-related paperwork. Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country RECOMMENDATIONS We will use this section to collect information about the required references you'll need in order for your application to be processed. An automated email will be sent to each one upon your submission of this form asking them to follow a link to a brief input form online. You may want to send a separate email letting them know to expect this, advising them to check their junk or spam folders in case they don't receive it.REGIONAL DIRECTOR*EXTENSION ONLY: Enter your CURRENT Regional Director. CHANGE OF FIELD: Enter your FUTURE Regional DirectorAFR-Randy AdamsASI-Lynden ShalmCAC-David SchwarzENA-Ken CantrellEUR-Nathan HarrodPAC-Roger BucklandSAM-Mike SponslerSUPERVISING MISSIONARY'S NAME (not an AIMer/AMPer)*EXTENSION ONLY: Enter your current Supervising Missionary's Name. CHANGE OF FIELD: Enter your most recent Supervising Missionary's Name. F L SUPERVISING MISSIONARY'S EMAIL*Use the @iag.email address. FUTURE SUPERVISING MISSIONARY'S NAME* F L FUTURE SUPERVISING MISSIONARY'S EMAIL*Use the @iag.email address. PASTOR'S NAME* F L PASTOR'S EMAIL* EXTENSION ONLY COUNTRY OF EXTENSION* MISSIONARY F L EXTENSION BEGIN DATE*Arrival on the field Month Day Year EXTENSION END DATE*Departure from the field. Month Day Year # OF MONTHS*1 month2 months3 months4 months5 months6 months7 months8 months9 months10 months11 months12 monthsPlease select the statement below that fits the best...* I will be returning to the field to begin this extension. I am on the field now and will remain here through the extension end date. Other If Other, please explain in 1-2 sentences.DATE OF ARRIVAL* Month Day Year My supervising missionary and Regional Director is aware of this extension request.* YES NO EXTENSION COMBO (Extension with a Change of Field)COUNTRY OF CHANGE OF FIELD* MISSIONARY F L EXTENSION BEGIN DATE* Month Day Year EXTENSION END DATE* Month Day Year # OF MONTHS*1 month2 months3 months4 months5 months6 months7 months8 months9 months10 months11 months12 monthsPlease select the statement below that fits the best...* I will be returning to the field to begin this extension. Other If Other, please explain in 1-2 sentences.DATE OF ARRIVAL* Month Day Year My supervising missionary and Regional Director is aware of this change of field request.* YES NO The missionary on location at my requested change of field is aware of this request.* YES NO STATEMENT OF INTENT I understand submission of this form will serve as legal instruction to extend my service as an AIMerCAPTCHAEmailThis field is for validation purposes and should be left unchanged.
