(Staple this page to front cover of application)

4-H SCHOLARSHIP APPLICATION COVER SHEET

Name / Parish:
First/Middle/Last
Address / Email:
Street/City/State/Zip

Applicants must be a class of 2018 high school graduate: Deadline: Friday, April 20, 2018 at 4:30 p.m. at the St. Charles Parish 4-H Office located at 1313 Paul Maillard Road, Suite E in Luling.

If you applied for the Louisiana State 4-H Foundation scholarship(s), you must still complete this application. You can print what you submitted for the Louisiana State 4-H Foundation scholarship and submit that application. Be sure that it follows all guidelines specified below before submitting.

Applications may be mailed to the following address:

St. Charles 4-H

Attn: Kali Zammit

P.O. Box 1766

Luling, LA 70070

*All applications must be RECEIVEDby Friday, April 20, 2018 at 4:30 p.m.

*SCHOLARSHIP REQUIREMENTS: In addition to the requirements listed above, scholarship applicants must submit the following:

  1. 4-H scholarship form must be typed.
  2. Transcript of grades, including mid-term grades of senior year.
  3. Copy of ACT scores.
  4. One letter of recommendation from an academic advisor.
  5. Any handwritten applications will be automatically deducted 5% of the total score from the judges.

HAVE YOU ATTACHED THE FOLLOWING?

  1. Scholarship Application Form (additional pages added only where option is given).
  2. Transcript of grades, including mid-term grades, signed by an appropriate official.
  3. Copy of ACT scores.
  4. Letter of recommendation from academic advisor on school letterhead stationery.
  5. Report the past three (3) years of club work. Use one page per school year.

SECTION 1

Personal / Academic Data

Name (First/Middle/Last)
Age / Date of Birth: / Month / Day / Year
Address
City / Zip / Parish
Gender
Name of Parents or Guardians
Number of Years in 4-H
Name and Address of High School
Grade / Class Rank / Number in Class / Cumulative GPA
Academic Honors received:
National Testing Score: / ACT / Date Tested / (attach copy of scores)
Name and address of college or school you plan to attend September 1st of this year:
In what field or course of study do you plan to major or concentrate?
Why have you chosen this field of study?

I have personally prepared/reviewed this application and believe it to be correct:

Signed Date

(Club Member)

Signed Date

(Parent or Guardian)

Signed Date

(Parish Extension Agent)

School Year

SECTION 2
4-H Leadership

List any time you taught, coordinated, organized or guided others through your 4-H work. List 4-H officer position(s) held, committees served on or other positions held. Leadership and community service develop with growth – younger members will have fewer examples.

Responsibility/Accomplishment(s) / Level
(L - Local, P - Parish,
S - State, N - National)
Example: Club demonstration – Taught 28 club members how to make a healthy snack. / (L)
Example: Served as safety chairman-school club; prepared monthly safety reports and activities for eight club meetings. / (L)

Only one page per school year.

School Year

SECTION 3

Citizenship/Community Service

How were you able to show your caring and citizenship qualities in 4-H this year? List

4-H activities you have participated in to help others in yourcommunity. Include hours/type of service/number of items donated, etc.

Description of Activity / Level
(L - Local, P - Parish,
R- Regional, S - State,
N - National)
Example: Donated 6 canned goods for Food for Families Food Drive. / (L)

Only one page per school year.

Only one page per school year.

School Year

SECTION 4

4-H Awards & Recognition

List the awards, honors, recognitions you have received in 4-H, including contests, workshops, trips, etc.

Award/Recognition / For What Received
Example:
Certificate of Participation / Attendance-
State 4-H Marsh Maneuvers
Example:
Certificate-Blue Ribbon / Area Commodity Ambassador Talk-Egg

Only one page per school year.

School Year

SECTION 5

Non-4-H Experiences – Leadership

List any time you taught, helped or guided others. List officer position(s) held, committee(s) served on or other positions held. Include only non-4-H work.

Responsibility/Accomplishment(s)
Example: Youth Praise Team; Captain-Softball Team

Non–4-H Awards & Recognition

Type of Award / For What Received
Example: Plaque-1st Place / Community Beautification Poster Contest

Only one page per school year.

SECTION 6

Impact Focus

How did your 4-H experiences help to influence your life?

What has 4-H done for you and how have you utilized that to impact your community and state?

Limit your story to 3 pagestyped only.

You may add up to 2 extra pages.

School Year

SECTION 7

Supporting Materials

  1. Transcript of grades, including mid-term grades, signed by school official.
  2. Copy of ACT scores.
  3. Letter of recommendation from academic advisor on school letterhead.
  4. Specific scholarship requirements, if applicable.
  5. Reminder – any handwritten application will be deducted 5% of your total score by the judges.

You may add up to 2 extra pages.