Junior Duck Stamp Program Contest Entry Form

Junior Duck Stamp Conservation and Design Contest

OMB Control No. 1018-0172
Expiration Date xx/xx/xxxx

Reference Form
http://www.fws.gov/birds/education/junior-duck-stamp-conservation-program.php
Students in Grades 7-8 IV must submit this reference sheet along with their entry to the Junior Duck Stamp Contest.
Remember that visual resources are reference materials and should NOT be copied. Please refer to the Annual Contest Brochure.
Student Information (Please print clearly)
First and Last Name:
State:
Grade:
___________________________________________________________________________________________________________________
Reference Information
While creating your Junior Duck Stamp Contest entry, you likely reviewed many sources. Please include your sources in the space below.
See examples in the Annual Contest Brochure. You may also include copies of your reference materials.
1._________________________________________________________________________________________________________________
2._________________________________________________________________________________________________________________
3. ________________________________________________________________________________________________________________
4._________________________________________________________________________________________________________________
5._________________________________________________________________________________________________________________
6._________________________________________________________________________________________________________________
7._________________________________________________________________________________________________________________
8._________________________________________________________________________________________________________________
9.________________________________________________________________________________________________________________
10. ________________________________________________________________________________________________________________

Visit http://www.fws.gov/birds/education/junior-duck-stamp-conservation-program/junior-duck-stamp-contest-information.php
for more information about this Reference Form.
In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the U.S. Fish and Wildlife Service collects information necessary to consider your submission for the Federal Duck Stamp Contest. Information requested in this form is purely voluntary.
Failure to provide all requested information may be sufficient cause for the U.S. Fish and Wildlife Service to reject your submission. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor and a person is not required to
respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 1018-0172. We estimate public reporting for this collection of information to average
20 minutes, including time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the form to the Service Information Clearance Officer, Fish
and Wildlife Service, U.S. Department of the Interior, 5275 Leesburg Pike, MS: PRB (JAO/3W), Falls Church, VA 22041-3803, or via email at [email protected]. Please do not send your completed form to this address.