Sample Documentation of Radio/TV Release	AFFACT-02 8-1-2014
Subject Area	Agriculture announcement
FCS announcement
Community Development announcement
4-H announcement
Attach copy of written transcript to this form if possible.
Date aired
Stations aired on
I certify that the announcement(s) aired as indicated above included Extension’s non-discrimination…”… offers its program to all eligible persons regardless of race, color, national origin, religion, gender, age, disability, marital or veteran status, or any other legally protected status, and is an Affirmative Action/Equal Opportunity Employer.” If the specific activity/event was announced the reasonable accommodation statement was included.
County Extension Agent	Date