Form Fgis-944 - Application For License Under The United States Grain Standards Act (Usgsa) And/or The Agriculture Marketing Act (Ama) Of 1946 Page 2

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Instructions for Completing Application for License
Official Agencies
Complete sections 1 - 15 on the Application with the following information:
1.
Applicant's Name. The complete name of applicant for license.
2.
Birthdate. The date of birth of the applicant (Month, Day, Year).
3.
Address. The applicant’s complete home mailing address, including zip code.
4.
Official Agency. The name of the employing official agency.
5.
Service Point. The service point location where the applicant will be stationed.
6.
Supervising Field Office. The FGIS field office that will supervise the applicant.
7.
Type of License. Place an “X” in the applicable box to indicate the type of license the
applicant is applying for.
8.
Previous License. Place an “X” in the applicable box to indicate whether the applicant
has previously been licensed by FGIS.
9.
License applying for. Place an “X” in the applicable box to indicate the type of license
for which the applicant is applying.
10.
Conflict of Interest. The applicant must answer the appropriate USGSA/AMA questions
by placing a check in the appropriate boxes.
11.
Signature of Applicant. The applicant's signature.
12.
Date. The date the applicant signs the application.
13.
Name and/or Signature of Agency Manager. The printed name and/or signature of the
employing Official Agency Manager, or their designee.
14.
Title. The title of the approving official signing in block 13.
15.
Date. The date the application was signed by the Agency Manager or designee.
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