Application for the Darren S

APPLICATION FOR THE FREDERICK COUNTY 4-H SCHOLARSHIP:

Must be a 4-H member in good standing, with the Frederick County 4-H Program.
Must be pursuing an education beyond high school (may be a trade school). No area of specification required
May apply for two (2) years, as a Senior in High School and Freshman or 1st year after High School

SCHOLARSHIP APPLICATIONS ARE DUE by 4:00 p.m. MARCH 1ST OF THE CURRENT YEAR.

Mail application along with a copy of your current transcript to:

FREDERICK COUNTY 4-H

ATTN: SCHOLARSHIPS

330 MONTEVUE LANE

FREDERICK, MD 21702

For additional information, contact Ms Jennie at 301-600-1589.

Disbursement:

Must have a 2.5 GPA
Given directly to the 4-H’er
A committee of no less than three people will review applications.
This scholarship can be used for tuition, books, or room and board.

FREDERICK COUNTY 4-H

Scholarship Application Form

______

NAME:______

(First)(Middle)(Last)

MALE:____ FEMALE:____ AGE: _____ (AS OF JAN. 1, OF THIS YEAR) DATE OF BIRTH:______

HOME ADDRESS:______

HOME PHONE #______

PARENTS / LEGAL GUARDIANS:

FATHER’S NAME & ADDRESS: ______

______

LIVING?______FATHER’S OCCUATION:______

MOTHER’S NAME & ADDRESS:______

______

LIVING?______MOTHER’S OCCUATION:______

NUMBER OF BROTHERS:______NUMBER OF SISTERS:______

PARENT / GUARDIAN PHONE NUMBER: ______

NAME & ADDRESS OF SCHOOL YOU WILL ATTEND ON OCTOBER 1 OF THIS YEAR: ______

______

WHAT CAREER DO YOU PLAN TO FOLLOW? ______

STATEMENT BY 4-H MEMBER: I personally have prepared this report and certify
that it accurately reflects my work.

Date: ______Signature of 4-H Member: ______

We have reviewed this report and believe it to be correct:

Date: ______Signature of Parent / Guardian:______

Date: ______Signature of 4-H Leader: ______

______

( SEE REVERSE SIDE FOR MORE DETAILS ON THE 4-H SCHOLARSHIP PROGRAM )

The University of Maryland is equal opportunity. The University’s policies, programs and activities are in conformance with pertinent Federal and State laws and regulations on nondiscrimination regarding race, color, religion, age, national origin, gender and disability. Inquiries regarding compliance with Title VI of Civil Rights Act of 1964, as amended; Title IX of the Educational Amendments; Section 504 of the Rehabilitation Act of 1973; and the Americans with Disability Act of 1990; or related legal requirements should be directed to the Director of Personnel / Human Relations, Office of the Dean, College of Agriculture, Symons Hall, College Park, MD 20742

SECTION A- ACADEMIC INFORMATION: (Complete all statements that apply)

High School: Grade:_____If not in high school, highest grade completed:______

College: Number of years:_____ Major: ______

1. Name & Address of High School: 2. Name & Address of High School:

______

3. National Testing Scores:

SAT: ______Date Tested: ______

Verbal Math

ACT: ______Date Tested: ______

4. Describe why you are interested in pursuing a college education: ______

______

5. Field in which you are majoring or plan to major: ______

______

6. Outline your reasons for choosing this field of study: ______

______

SECTION B- FINANCIAL INFORMATION

1. List any anticipated college costs for the next year:

Tuition Fees $______Board $______Lab Fees $______

Personal Exp. $______Room $______Books $______

Clothing $ ______Transportation $______

Other:______

2. Explain your need for financial assistance. Describe how you would use this
scholarship and your plans for meeting this financial need:

______

3. Will you have any brothers or sisters attending college during the next year?

Yes_____No_____If yes, explain: ______

______

4. Will you be receiving or will you be a candidate for any other scholarship for the next year?

Yes_____No_____If yes, explain: ______

______

5. Will you be receiving or have applied for any other educational loans for the next year?

Yes_____No_____If yes, explain: ______

______

6. Have you completed the Student Financial Aid Form? Yes______No______

SECTION C- EXPERIENCES IN 4-H

1. Major 4-H Projects: ( Give number of years)

______

2. Major 4-H Awards Received:

YearType of AwardFor What ReceivedLevel

3. Major 4-H Offices Held: ( Club, County, District, State, Collegiate )

______

SECTION D- 4-H CITENZINSHIP / LEADERSHIP EXPERIENCE

List in chronological order your 4-H citizenship / community service experiences:

Include things that contributed to the welfare of your club, or group members, other individuals, or community. Indicate the size and scope of what you did.

______

SECTION E-CITENZINSHIP / LEADERSHIP EXPERIENCE OTHER THAN 4-H

______

SECTION F- CAREER PATHING

Write a brief summary of how your decision to apply for this particular scholarship was

(1) influenced by your 4-H experiences and (2) impacts upon your choice of career.

______

DO NOT ADD ADDITIONAL PAGES