Bellcountyyouth Fair

BELLCOUNTYYOUTH FAIR

SCHOLARSHIP APPLICATION FORM

2016

For scholarship consideration, you must:

1. Be a high school senior for 2015-2016.
2. Be a participant of the 2016 Bell County Youth Fair and Livestock Show, plus have participated in the fair a minimum of one other year.
3. Be eligible to attend a two-or four-year College, university or technical school as a full time student (12 hours per semester) for the 2016-2017 school year.
4. Complete this scholarship application form and submit it to the Bell County Extension Office, Attn: BCYF Scholarship Program, 1605 North Main, Room 102, Belton, TX 76513 by 5:00 p.m. on April 8, 2016. Any applications received after 5:00 p.m. April8, 2016 will not be considered.

CHECKLIST:

To be considered for the scholarship, please check off that you have the following items:

Please note that typed applications are preferred. Please input information on the pages provided – any additional pages added will not be considered.

Completed application form for

(Applicant)

Official Transcript Attached – must be sealed by a high school counselor or principal

Essay Attached

All Requested Signatures Obtained:

Parent/Legal Guardian

High School Counselor/Principal

High School Ag Teacher/Home Economics Teacher or Adult Club Supervisor

Applicant

ESSAY: Please answer the following question in essay format. Please limit your answer to a maximum of 750 words. Please format your attached typed document to a size 12 Times New Roman font.

2016 Scholarship Essay Question: What was your most defining moment during your years

with the BellCounty Youth Fair, and how did this moment contribute to your personal growth?

Page 1 of 5

Bell CountyYouth Fair Scholarship Application Form

Full Name

LastFirstMiddle

Address

StreetCityStateZip

College, University or TechnicalSchool that you plan to attend

Field of Study Acceptance Letter Received? No Yes

Planned length of study - choose one only: Two-year program Four-year degree

FINANCIAL INFORMATION

Parent or Legal Guardian’s Name(s)

Parent(s) or Legal Guardian(s) Adjusted Gross Income for 2014 (line 37 on IRS 1040 form; line 21 on 1040A or 1040EZ):

Below $35,000 $85,000 - $109,999# of members in household including you

$35,000 - $59,999 $110,000 - $134,999

$60,000 - $84,999 Above $135,000# of members from household attending

College during the 2016-17 year

Note: In reporting family incomes use the parent/step-parent or legal guardian income from the house in which you reside predominantly. Include both parent, step-parent or guardian incomes from the household.

Has there been any significant change in your financial situation within the past year, or is there any other financial information we should take into consideration? No Yes

If yes, explain:

TO BE SIGNED BY A PARENT OR LEGAL GUARDIAN:

I certify that the financial information listed above pertaining to is correct. I

(Applicant’s Name)

understand that the scholarship committee has the right to request proof of financial information, and that any false information given will result in immediate disqualification from scholarship consideration.

Signature Please Print Name Date Contact Phone #

Page 3 of 5

Page 3 of 5

Please list details of your participation in the Bell County Youth Fair and Livestock Show. List all years (up to 10 maximum) that you participated. This page only – additional pages will not be considered.

Page 4 of 5

For your high school years only, please list details of your 4-H, FFA, and/or FCCLA involvement. Please include any LEADERSHIP roles (ex. - club officer, committee, chair, etc…).

For your high school years only, please list 4-H, FFA, and/or FCCLA achievements, any awards and the years for each:

TO BE VERIFIED AND SIGNED BY A CLUB SUPERVISOR, AG OR HOME ECONOMICS TEACHER:

I certify that the club involvement information listed above pertaining to is correct.

(Applicant’s Name)

4-H Supervisor(if 4-H information is listed):

Signature Please Print Name Date Contact Phone #

FFA Supervisor(if FFA information is listed):

Signature Please Print Name Date Contact Phone #

FCCLA Supervisor (if FCCLA information is listed):

Signature Please Print Name Date Contact Phone #

Page 5 of 5

For your high school years only, please list any other extra-curricular activities outside of 4-H, FFA and/or FCCLA:

Please list any community service projects that you participated in during high school:

Please list any jobs held during high school. Include co-op programs and summer work: