Appendix D to Part 514 - Annual Report - Exchange Visitor Program Services (GC/V), United States Information Agency, Washington, DC20547, (202-401-7964)

Exchange Visitor Program No. ___ Reporting Period ___ Provide Range of Forms IAP-66 Documents Covered by this Report (___-___).

(a) STATISTICAL REPORT (1) ACTIVITY BY CATEGORY NumberProfessor ____Research Scholar ____Short-term Scholar ____Trainee ____Student (College and University) ____Student (Practical Trainee) ____Teacher ____Student (Secondary) ____Specialists ____Physicians ____International Visitors ____Government Visitors ____Camp Counselors ____Total ____(2) Forms IAP-66 Reconciliation(i) Number of Forms IAP-66 voided or otherwise not used by participant ____(ii) Number of Forms IAP-66 issued for dependents ____(iii) Number of Forms IAP-66 currently on hand ____ (b) PROGRAM EVALUATION

On a separate sheet, please provide a brief narrative report on program activity, difficulties encountered and their resolution, program transfers, anticipated growth and the proposed new activity, cross-cultural activities, as well as the reciprocal component of the program.

I, The Responsible Officer of the program indicated above, certify that we have complied with the insurance requirement (22 CFR 514.14). I also certify that the information contained in this report is complete and correct to the best of my knowledge and belief.

Responsible Officer(signed) Date Name and address of sponsoring institution