Application is due to county Extension office by county deadline. Applications must be approved and signed by county 4-H agent who will then forward applicationsto the State 4-H office by March 1.

County offices should mail applications to:Roberta Lundeberg

106 Ballard Hall

OregonStateUniversity

Corvallis, OR97331

Applicant Information

Name M F County

Mailing Address

City State ___ Zip Code

Home Phone No:______Cell: ______

Email

CurrentGrade Name of School CurrentlyAttending______

Name of Parent(s) or guardian(s):

Name and address of college or school you plan to attend:

Anticipated course of study: ______

What career do you plan to follow? ______

Number of Years in 4-H (including this year) ______(include only Grade 4 and above)

High School Cumulative GPA: __Rank in Class_____Class Size______

ACT or SAT Score(required; no exceptions):

Include a copy of your high school (and college) transcripts (current as of January 1)and acopy of your official SAT or ACT scoreswith this application (photocopy of official scores is acceptable).

Please refer to the State 4-H Scholarship eligibility criteria page, and indicate below which scholarships you are eligibleand applying for:

Requires attendance at OSU:

_____Martha MacGregor Memorial 4-H Scholarship

_____Kate Thiess Memorial 4-H Scholarship

_____Klein-Youngberg Family 4-H Scholarship (not yet confirmed for 2013)

_____Oregon 4-H Foundation Memorial 4-H Scholarship

_____Ted and Betty Dietz Memorial 4-H Scholarship

_____Minnick Memorial 4-H Scholarship (preference to those with agricultural

background)

_____A. Lois Redman 4-H Scholarship (Must have at least 3 years in Home Economic projects, with a preference given to applicants college major. See detailed description on 4-H website.)

For attendance at any college or university:

_____CHS Foundation Scholarship

_____Duane Johnson 4-H Scholarship

_____OM Plummer Scholarship (Must have participated in beef/sheep/swine

clubs or livestock judging)

_____Babe Coe Memorial Scholarship (Must be from Crook, Deschutes, Grant,

Jefferson or WascoCounty and have been in 4-H for at least 5 years). Requires completedOregon 4-H Financial Need Form

_____ Jeanne Leeson Memorial 4-H Scholarship

_____ H. Joe Myers Memorial 4-H Scholarship

Project areas: List three main 4-H project areas you have had the most involvement with

Project area / Years (ex: 2007- 2010, 2012)

STATEMENT BY 4-H MEMBER

I have personally prepared this application and believe it to be correct. I meet all the eligibility requirements for the scholarships I am applying for.

Date:Signature of 4-H Member

4-H Media Release

Material provided for State 4-H scholarship application is occasionally used for educational or promotional purposes (for example, the display boards at State Fair). If you are willing to let the material you submit in your application to be used publicly, please sign below.

I authorize OregonStateUniversity, and those acting pursuant to its authority to:

(1)Use my child’s photo, name, and/or biographical information supplied in this application in material published by the university. Such material may be published via photograph, videotape, audiotape, film, internet, or record in any other medium.

(2)Exhibit or distribute such material in whole or in part without restrictions or limitations for any educational or promotional purpose that OregonStateUniversity and those pursuant to its authority deem appropriate.

Furthermore, I waive any right I or my child might have to inspect and/or approve the finished medium or the use to which it may be applied.

Date:_____Signature of 4-H Member

Date:Signature of Parent/Guardian

APPROVAL OF THIS APPLICATION

We have reviewed this application and scholarship eligibility criteria and believe it to be correct. Applicant meets required scholarship eligibility criteria, and I support this member’s application.

DateSigned (parent/guardian):

DateSigned (county Extension 4-H agent):

OREGONSTATE 4-H SCHOLARSHIP

APPLICATION PROCESS

Scholarship applications must includethe items below, in the following order:

  1. Completed application form, signed by 4-H member, parent or guardian, and county

4-H agent.

2. My 4-H Story.

  • Your story should be a description of what you have learned and experienced through your 4-H participation. Include how 4-H has impacted your life and how you have impacted the lives of others. Also include what you plan to study in college and how 4-H has influenced your choice.
  • Minimum of three pages; maximum of four pages.
  • Must be type-written on one side, double-spaced, with a 1 ½ inch margin on the left side and a 1 inch margin on the right, top, and bottom of the page.
  • Use either Times New Roman or Arial font and 12 point type.
  • Type your name and county in the upper right corner of the first page.
  • Be sure all information is accurate and that spelling and grammar are correct.
  1. My 4-H Resume
  • Up-to-date through February of current year
  • Submit the entire resume
  1. A copy of high school transcript (current as of January 1) and a copy of official SAT

or ACT scores (photocopy is acceptable). Include a copy of college transcript if applicable.

  1. A copy of Oregon 4-H Financial Need Form if eligible for the Babe Coe Memorial

4-H scholarship.

All submission material should be placed in a flat, stiff 8 ½ x 11 inch binder. (Three-ring binders are not acceptable.) Please be sure material is securely fastened inside the binder. Put your name and county on the upper right corner of the cover (unless the cover is clear and your name and county can be seen on the application inside).

Selection is based 55% on the Resume, 35% on the story, and 10% on GPA.

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