| First Name: | |
| Last Name: | |
| Street Address: | |
| Street Address (cont.): | |
| City, State, Zip: | |
| Home Phone: | |
| E-Mail: | |
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| My family income is $60,000 or less and I am one of the following: |
| | Member of Michigan Farm Family. |
| | Closely associated with agriculture activites. |
| | Resident of a small rural community. |
| |
| I would like information/application for the following: (check all that apply) |
| | TARFF Loans |
| | 4-H/FFA Special Project Loans |
| |
| College/School I plan to attend: | |
| Term/Year I plan to attend: | |
| I learned of MRRC from: | |
| Other comments/questions: | |
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