JANICE THARP JIRIK/BEVERLY YOST MEMORIAL
4-H SCHOLARSHIP
Award
One $250 Scholarship
Eligibility
1. Applicant must have graduated from high school, but not be older than age 24.
2. Applicant must have been a Kingfisher County 4-H member three (3) or more years during their 9th-12th grade years of high school.
3. Applicant must have submitted a State 4-H Record Book for competition at least one time during their 4-H career.
4. The Jirik Scholarship can be received one time only per applicant.
5. Applicant must show a personal commitment to higher education.
Required Materials
1. Janice T. Jirik Scholarship form.
2. Transcript of all school work.
3. Proof of current enrollment in college.
4. A 250-500 word essay titled: “How 4-H Membership Has Influenced My Career Plans and/or My Life.”
5. Letter of Recommendation, (excluding Kingfisher County OSU Extension Staff.)
Application Process
1. Turn in required materials to the Kingfisher County OSU Extension Center by June 30th of each year.
2. Scholarship will be announced at the 4-H Banquet. Half will be sent to the college of your choice at that time and half at the next semester after proof of grades and enrollment have been received. Must provide grades and proof of enrollment as a full-time student and maintain a 2.0 GPA.
JANICE THARP JIRIK/ BEVERLY YOST MEMORIAL 4-H SCHOLARSHIP
APPLICATION FORM
1. Application should be typed and filled out in detail.
2. Attach a copy of all transcripts to applications.
3. No additional pages may be used to answer questions.
4. Sign the application.
5. Submit to the Kingfisher County Extension Office by June 30th.
I. GENERAL INFORMATION:
A. First, middle, and last name ______
B. Age on January 1st of this year ______Date of Birth:______
C. Social Security Number ______
D. Residence: Home Address ______
Home City, State, Zip ______
Home Phone Number ______
School Address (if different from home) ______
______
School Phone (if different from home) ______
E. Parent’s or Guardian’s Name______
Address ______
City, State, Zip ______
II. ACADEMIC INFORMATION:
A. Year in School August 31st.
College: _____Freshmen _____Sophomore _____Junior _____Senior
Technical or Trade School: Kind ______
B. Name and address of High School attended:______
______Zip______
C. Date of High School Graduation ______(Required)
D. College, University, or Trade Schools attended beyond high School:
Name of Institution Dates Attended Credits Earned Scholastic Average
______
E. Scholastic Organizations or Honors received:
______
III. EDUCATIONAL PLANS:
A. School where you plan to further education: ______
B. Describe why you are interested in pursuing an advanced education:
______
C. Field in which you are majoring or plan to major:
______
D. Outline your reasons for choosing this field of study:
______
______
IV. FINANCIAL INFORMATION: (Required)
1. List anticipated college costs for the next year:
Tuition Fees $_____ Board $_____ Lab Fees $_____
Personal Exp. $_____ Room $_____ Books $_____
Clothing $_____ Transportation $_____
Other $______
2. Describe how you would use this Scholarship and your plans for meeting this financial need:
______
V. 4-H ACCOMPLISHMENTS:
List your most important 4-H accomplishments. Limit responses to space provided.
A. Number of years enrolled as a Kingfisher County 4-H member:______
B. Years submitted State 4-H Record Book:______
C. Major accomplishments in 4-H project work: ______
D. List or describe outstanding 4-H citizenship and leadership activities:
______
E. 4-H Offices Held:
______
F. 4-H Honors Received:
______
G. Other 4-H Activities:
______
VI. OTHER INTERESTS AND ACTIVITIES:
A. School______
B. Community______
C. Church______
D. Hobbies and Special Interests ______
I have personally prepared this application and believe it to be correct:
Date ______
(Signature of Applicant)