DEADLINE: March 1, 2011.

Transcription

1 2011 Texas 4-H Collegiate Scholarship Application Deadline: March 1, 2011 The Collegiate 4-H Scholarships are scholarships provided to students who are currently enrolled in a Texas college or university. These scholarships ranging from $1,500 to $1,800 are sponsored by the Volunteer Leaders Association of Texas, the Texas 4-H Friends and Alumni Association, and Producers Cooperative Association of Bryan, TX. SCHOLARSHIP ELIGIBLILITY To be eligible for the Texas 4-H and Youth Development Collegiate Scholarship, you must: Have actively participated in 4-H during high school years. Be attending a Texas college or university and will be attending a Texas college or university to use these scholarship funds if the scholarship is awarded to you. Have successfully completed or will have successfully completed 30 semester hours of undergraduate college work by the time scholarship payments are initiated in Fall Volunteer Leaders Association of Texas Scholarship: Carrying a minimum of a 2.7 cumulative overall GPA for course work completed as of the date of this application. Texas 4-H Friends and Alumni Association Carrying a minimum of a 2.7 cumulative overall GPA for course work completed as of the date of this application. Current member of the Texas 4-H Friends and Alumni Association Completed two years at a Texas College/University Currently enrolled as a full-time student. Producer s Cooperative Association of Bryan, TX Limited to a geographical region of the following counties: Brazos, Burleson, Grimes, Leon, Madison, Milam, Robertson, Waller, & Washington. Active member of the Texas 4-H and Youth Development Program for at least three (3) years. Applicant must come from an agricultural background as demonstrated in the application. Applicants from the Blinn College System will be given first priority, if no applicant from Blinn is received, other college/university applicants can be considered. INSTRUCTIONS Complete the application as completely as possible in the space provided according to the following page schedule - please do not add pages or write on the reverse side of any page. A copy of your college transcript(s) listing all undergraduate course work completed must be attached to the application for submission. Personal Data... Page 2 Application Certification... Page 2 College/University/Career Information... Page 2 Family Information... Page 3 Financial Information... Page 4 4-H Career... Page 5 Collegiate Activities... Page 5 College Transcript(s)... Attachment Scholarship awards will be based on: Financial need. Scholastic ability/achievement 4-H participation. 4-H and collegiate leadership and involvement. SCHOLARSHIP APPLICATION EVALUATION SCHOLARSHIP APPLICATION DEADLINE The completed application, with a copy of your college transcript(s) attached by a staple, must be forwarded directly to the Texas 4-H Youth Development Office at the address below. Scholarship application must be mailed to the address below and postmarked no later than the deadline. DEADLINE: March 1, Texas 4-H and Youth Development Program c/o Collegiate Scholarship 4180 S Highway 6 College Station, Texas 77845

2 2 SECTION 1: PERSONAL DATA Application Submission Category (Baccalaureate or Technical) Last Name First Name Middle Name (No Initials) Nickname (if applicable) Gender Home Address City State Zip County District (1 through 12) Home Telephone Cellular Telephone Number (if applicable) Address Social Security Number Date of Birth Are you a citizen of the United States? (Yes/No) Are you a Texas resident? (Yes/No) Number of years you have been in 4-H? Are you a current member of the Texas 4-H Friends and Alumni Association (Yes/No) TX SECTION 2: APPLICATION CERTIFICATION I certify that the information contained herein is correct and truthfully reflects my personal, 4-H and academic background and records. I agree that, if any information contained herein is found to be falsified in any way, my application will automatically become null and void. I hereby authorize any person, firm or entity to release to the Texas 4-H and Youth Development Program, or the scholars donor, information concerning the subject matter of the statements I have made in this application, including, but not limited to, information concerning my academic record, activities, honors and awards, citizenship or residency, and financial situation. A copy of this authorization is agreed by the undersigned to have the same effect and force as an original. Any person, firm or entity releasing matters pursuant to this authorization is hereby absolved from any liability. Signature of Applicant Date SECTION 3: COLLEGE/UNIVERSITY CAREER PLANS Name of College/University You are Attending Major/Course of Study Chosen for Baccalaureate Degree/Technical Certification Department/College in which this major is offered? What is your preferred career choice? Overall GPA Major GPA Total Hours Completed Number of Semester from Graduation Anticipated date of Graduation

3 3 SECTION 4: FAMILY INFORMATION Parent s/guardian s Address: Parent s/guardian s City, State, & Zip: Is your Father/Guardian Living? (Yes/No): What is your Father/Guardian s Occupation?: What is your Father/Guardian s Professional Title?: Who is your Father/Guardian s Employer?: What is your Father s/guardian s Work Phone Number?: Is your Mother/Guardian Living? (Yes/No): What is your Mother/Guardian s Occupation?: What is your Mother/Guardian s Professional Title?: Who is your Mother/Guardian s Employer?: What is your Mother s/guardian s Work Phone Number?: Please explain if you live with a guardian, grandparent, or have other living arrangements that would be beneficial to your application?: Brothers Ages of Brothers: Sibling Information Does this brother live at home? (Yes/No): During your college career, will this sibling also be attending college? (Yes/No): Sisters Ages of Sisters: Does this sister live at home? (Yes/No): During your college career, will this sibling also be attending college? (Yes/No):

4 4 SECTION 5: FINANCIAL INFORMATION Expected College Cost and Personal Savings Name of College/University: College Cost Tuition per semester hours: $ Books & fees per semester: $ Housing per Semester: $ Are you living in a dormitory? (Yes/No): Food per semester: $ Recreation and travel per semester: $ Name of Donor/Name of Scholarship or Loan You Currently are On or Have $/Year # of Years Total Amount Origination Date In each of the categories listed below, indicate the amount of assistance you have had and may expect to continue to have to pay your college expenses each semester if you do not receive this scholarship. Scholarships Loans Parents Personal Assets Work Other TOTAL Briefly state why you need additional financial assistance and why you should receive this scholarship (minimum of 10 point font and do not add pages).

5 5 4-H CAREER No. of years enrolled Name of 4-H club(s) List the four most significant 4-H projects during your 4-H career. Year(s) Project Title Activities Related to this Project List the five most significant 4-H leadership and citizenship activities during your 4-H career. Year(s) Activity Your Function Relating to this Activity List the five most significant 4-H achievements or honors you received during your 4-H career. Year(s) Achievement/Honor Club County District State National COLLEGIATE ACTIVITIES List four collegiate activities and leadership responsibilities (include social and service clubs, sororities/fraternities, church, campus committees, etc.) Year(s) Organization Name Office Committee Other

6 6 COLLEGIATE ACTIVITIES SUMMARY Please provide in the space below a brief summary of your college career including your involvement in organization, success in your major area, awards/honors, and/or challenges faced and overcome.