Waukesha Leaders Association Scholarships

WAUKESHACOUNTY 4-H LEADERS’ ASSOCIATION
SCHOLARSHIP APPLICATION FORM

The applicant’s basic information and signatories will only appear on this cover sheet. A unique Applicant ID Number will be placed on this cover page and on the member’s scholarship application form that is attached. Before the scholarship form is given to the evaluators, this cover sheet, with all the personal information it contains, will be removed.

This has two significant implications for you, the scholarship applicant:

1.Since our evaluators don’t want to be swayed by any personal knowledge that they may have of the member whose form is being judged, this will help them remain unbiased.

2.The evaluators will not be able to fill in any items omitted by you that their personal knowledge would have provided. For instance, if you forgot to write down that you worked at the 4-H food stand, no one will be able to fill that in for you. Your scholarship form will have to stand on its own.

Member Information

Club Organizational Leader or Leadership Team Affirmation

Review this completed form with your club or unit organizational leader and obtain his or her signature.

As the general leader of the ______club, I ______affirm that this scholarship applicant is an active 4-H member and that the information provided on this form is accurate to the best of my knowledge.

Club Organizational Leader Signature: ______Date: ______

Applicant Affirmation

By applying for this scholarship, I fully realize my responsibility to pursue my higher education and will make every effort to do so. I affirm that the information provided on this form and all supporting documents, to the best of my knowledge, are true and accurate.

Signature: ______Date: ______

WAUKESHACOUNTY 4-H LEADERS’ ASSOCIATION
SCHOLARSHIP APPLICATION FORM

Complete all information on this page. Type, computer print, or neatly hand print with black ink.

Use 12 point or larger font size. (This sentence is 12 point.) Smaller size will not be accepted.

All information must be able to be verified (i.e. 4-H Record Book) or it will not be accepted.

You cannot substitute this form with your own. If you have problems, ask for help. Substitutes will not be accepted. Remember that you are being evaluated and neatness does count.

Member Information

Scholastic Information (20%)

Answer the essay question below.
Tell everything you feel is important but be concise. Your answers must fit inside the box in 12-point character size.

Write about your vocational choice and why you have chosen this field.

4-H Club Achievement/Leadership Information (40%) (Must be able to verify all information in 4-H Record Book)

Scholarship Application Form – Page # 1 Rev. 16 September 18, 2015

In the table to the right, enter the calendar year in which you received the award.
If you have not received one, leave it blank.

In the tables below, enter the number of items for each 4-H year. If there are none for a given year, leave it blank.
Total each row into the far right box then total the far right. columns for a grand total.

Scholarship Application Form – Page # 1 Rev. 16 September 18, 2015

Project Achievement:

Club Participation and Leadership:

Answer the essay question below.
Tell everything you feel is important but be concise. Your answers must fit inside the box in 12-point character size.

Explain what you feel is your most significant achievement in your Club and why.

4-H Club Achievement/Leadership Information (Continued)

Answer each essay question below.
Tell everything you feel is important but be concise. Your answers must fit inside the box in 12-point character size.

What leadership roles have you experienced while a member of your 4-H Club and what impact did it have on the Club and its members?

What was the most significant benefit you received from being a member of your 4-H Club?

What was the most significant contribution you made to improve your 4-H Club?

4-H County Achievement/Leadership Information (20%) (Must be able to verify all information in 4-H Record Book)

In the table below, enter the number of items for each 4-H year. If there are none for a given year, leave it blank. Total each row into the far right box then total the far right columns for a grand total.

Answer each essay question below.
Tell everything you feel is important but be concise. Your answers must fit inside the box in 12-point character size.

Explain the 4-H County program that benefited your life skills the most and why.

What was the most significant contribution you made to improve the WaukeshaCounty 4-H program.

4-H State & National Achievement/Leadership Information (10%) (Must be able to verify all information in 4-H Record Book)

Scholarship Application Form – Page # 1 Rev. 16 September 18, 2015

In the table to the right, enter the calendar year in which you received the award.
If you have not received one, leave it blank.

* Add any State Conference other than a Delegate.
Example: Showcase, Drama, Press Team, etc.

Answer the essay question below.
Tell everything you feel is important but be concise. Your answers must fit inside the box
in 12-point character size.

Scholarship Application Form – Page # 1 Rev. 16 September 18, 2015

Explain how State and National 4-H programs can benefit the life skills of 4-H members.

Non 4-H Participation and Community Service (10%)

Enter the number of items for each 4-H year in the tables below. If there are none for a given year, leave it blank.

Total each row into the far right box then total the far right columns for a grand total.

Answer the essay question below. Tell everything you feel is important but be concise.
Your answers must fit inside the box (remember the 12 point character size).

Explain the most important contribution you gave to your church, school, or community?

Scholarship Application Form – Page # 1 Rev. 16 September 18, 2015