For Graduating High School Seniors

FAYETTE COUNTY 4-H

SCHOLARSHIP APPLICATION

for graduating High School Seniors

DEADLINE FOR SUBMISSSION: April 24, 2017

Must be typed; font Arial 11 or 12. No additional pages attached.

NAMEAGEDATE OF BIRTH

ADDRESSPHONE

CITYSTATE OH ZIP

CLUB/GROUP NAMEYEARS IN 4-H

PLANNED CAREER

COLLEGE ACCEPTED INTO & ATTENDING

Submit a letter of recommendation from a 4-H advisor (not a county Extension Educator), a teacher, school administrator, or a community leader, not related to you. The letter must be in a sealed envelope with their signature across the seal. This is a requirement.

Official High School Transcripts will be required. Please notify your high school guidance counselor that the OSU-Fayette County Extension Office will be picking up your transcripts to be reviewed by the 4-H Committee.

I personally have prepared this record and certify that it accurately reflects my work:

Date______Signature of 4-H member______

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

Date______Signature of Parent/Guardian______

Date______Signature of 4-H Advisor/Volunteer______

Date______Signature of Extension Educator, 4-H______

DO NOT ATTACH ADDITIONAL PAGES or

TYPE on theBACKSIDE

(applicantwill be disqualified)

LIST 4-H PROJECTS COMPLETED AND AWARDS RECEIVED:

PROJECT TITLE AWARD

LIST EVENTS AND ACTIVITIES YOU HAVE PARTICIPATED IN DURING YOUR 4-H YEARS INCLUDE ANY LEADERSHIP ACTIVITIES and COMMUNITY SERVICE:

EVENT/ACTIVITY WHAT YOU DID

LIST ANY OFFICE AND OR COMMITTEES YOU WERE ELECTED OR APPOINTED TO. Describe what you did (but do not list if you did not actually do anything):

OFFICE HELD OR COMMITTEE WHAT YOU DID

LIST ANY MAJOR HONORS OR AWARDS: (this may also include honors or awards received outside of 4-H)

LIST ANY NON-4-H ACTIVITIES YOU ARE OR HAVE BEEN INVOLVED IN: (Include church, community and school. Limit list of activities to this page).

NAME OF ACTIVITY

HOW HAS YOUR 4-H EXERIENCE HELPED YOU? (a brief essay on your personal growth through 4-H. Essay should not exceed this page)

ACADEMIC INFORMATION

Name of LastHigh School Attended:

Date of (Expected) Graduation: Grade Point Average (4.0 Scale):

Class Rank: Total Number in Graduating Class:

Academic Honors Received:

ACT Score: SAT Score:

Name and Address of Post-Secondary School(s) Attended (if any):

Years Completed of Post-Secondary: Grade Point Average (4.0 Scale):

FINANCIAL INFORMATION:

1. Please explain how you plan on paying for your college education and any special financial circumstances:

2. Please list any scholarships and the amount you have been awarded for your college freshman year, 2013/14:

Please write a short essay on what benefits you will derive from receiving a 4-H Catherine Jean Brown 4-H Fayette County Scholarship. (Essay cannot exceed this page.)

Revised February 9, 2017