THE FARM BUREAU

AGRICULTURAL YOUTH SCHOLARSHIP 2013

Deadline: November 18, 2012 postmark. APPLICATION MUST BE TYPED.

Applicants must be high school seniors. See information sheet for further detail.

This form may be reproduced with the original format maintained.

NO HANDWRITTEN APPLICATIONS WILL BE ACCEPTED.

Please attach:

**2 REFERENCE NAMES – Name, Address and Phone Number ONLY (limit of one teacher)

LETTERS ARE NOT NECESSARY

  **AN ESSAY "If you had the power to change something in your community or on your farm, what would you change and why?” The essay should not exceed two pages, one side double-spaced, using a minimum of a 10 font size.

§  This essay may be presented orally at the District level. The First Place state winner will be invited to present the essay at a New York Farm Bureau event. Oral presentations may be enhanced, with any and all enhancements the sole responsibility of the applicant for presentation purposes. (5 Minute limit)

  A RECENT PHOTOGRAPH – Wallet size photo ONLY, a 300 dpi (minimum) of a head/shoulder shot; sorry no school photos due to copyright laws. All photographs submitted by entrants become the property of New York Farm Bureau and may be used for promotional purposes. Photos will not be returned. The submission of a photo and signature on the application form by the applicant is evidence of consent to the above conditions. Applicants under the age of 18 must also include the signature of a parent or legal guardian.

NAME: DATE OF BIRTH:

ADDRESS:

TELEPHONE: E-MAIL ADDRESS:

PARENT/GUARDIAN: COUNTY:

LOCAL NEWSPAPER NAME/ADDRESS:

Farm Bureau Membership# Family OR Student (CIRCLE ONE)

(Membership application may accompany your submission.)

HIGH SCHOOL:

Chosen Occupational Field:

College/Technical School/Internships, etc. planning to attend:

Major Course of Study Planned:

Do you live or work on a farm?

Please list your farm/agricultural responsibilities:

What has inspired you to want to continue your family’s commitment to agriculture?

If you do NOT live or work on a farm, do you work for an agribusiness?

Please include the business name and your work responsibilities:

Describe an event that motivated you to purse a career in agriculture.

What does Farm Bureau mean to you and your family?

List all involvement in agricultural, school and community activities, including offices or leadership roles and awards/recognition (you may attach additional pages)

Organization / Dates of Participation / Role/Awards/Recognition

REMINDER: DEADLINE IS November 18, 2012 postmark

What are your agricultural leadership goals for the next five years and how has your involvement in agriculture shaped you as a person?

I certify that I am a High School Senior

Applicant Signature

Parents or Guardians Signatures (if applicant is under eighteen)

Please be sure that your application is complete with all attachments.

NO hand written applications will be accepted.

Please mail your completed application by November 18, 2012, with attachments to:

New York Farm Bureau, Att: Scholarship Comm.

P.O. Box 5330

Albany, NY 12205-0330

1-800-342-4143.

For District Winners: By January 18th, 2013, District judging will be complete, and you will have an opportunity to make minor changes (i.e. grammar, spelling, additional awards etc.) to your application prior to the February 1st final deadline to New York Farm Bureau for the state judging.