Georgia 4-H Achievement Scholarship Application

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1 Georgia 4-H Achievement Scholarship Application If you wish to be considered for scholarships that consider your financial need, please check the following box and complete and attach the statement of need. I wish to be considered for a S.A.F.E. Scholarship. PERSONAL INFORMATION Name County _ Home Address Street City State Zip Code Address Phone Number Age of Birth Year in College Incoming Freshman Freshman Sophomore Junior Senior Applicants must summarize, highlighting the information you feel most important for the scholarship committee to know about you. Do not add extra pages, except for the required personal statement, resume, and transcript. If you wish to be considered for the scholarships that consider financial need, attach the statement of need. Please complete the Georgia 4-H S.A.F.E. portion of the application, if you wish to be considered for these scholarships. Only use the provided space on the application to answer questions. EDUCATIONAL STATUS Name of college/university at which you have been accepted for the fall semester. If the University of Georgia, to what college or school did you apply? If you have not received an admission decision, list the schools you have applied to. General Area of Study (check all that apply) Agriculture Family and Consumer Sciences Business Education Other Specific Major If you are enrolled in high school, please list: Grade Point Average Highest SAT Score Critical Reading Math Writing (if applicable) Highest ACT Score English Math Reading Science Composite Writing (if applicable)

2 If you are enrolled in college, please list: Grade Point Average Please Check All that Apply Are you currently active in a collegiate 4-H program? Yes No Have you received a Georgia 4-H Achievement Scholarship in the past? Yes If yes, please include the name(s) of scholarship(s) received and year(s). Name of Scholarship No Year Received Have you mastered in a 4-H project or special event? Yes No If yes, please include the project(s) or special event(s) you mastered in and year(s). Name of Project and/or Special Event Year Received The following items are required and must be received by the Georgia 4-H Foundation by the due date to be considered for all available scholarships: Official Copy of Transcript Applicant Signature 4-H County Extension Staff Member Signature Personal Statement Use one separate page to tell the committee about yourself beyond what is already your application. Limit one page only, 12 point font, double spaced. Resume Limit two pages, 10 point font, ½ inch margins minimum. Statement of Need If you wish to be considered for scholarships that consider your financial need. Use the space provided on page four of the application. Georgia 4-H S.A.F.E. Application If you wish to be considered for these scholarships. Use the space provided on page five of the application. Signature of Applicant Signature of 4-H County Extension Staff Member

3 Georgia 4-H Achievement Scholarship Statement of Need Complete ONLY if you wish to be considered for scholarships that review your financial need. Please complete this form and attach to your application. Please limit explanation to the space provided. Have you or do you plan to file for Free Application for Federal Student Aid (FAFSA)? Yes No Are you your sole support and will not receive assistance from parent/guardian? Yes No DETERMINATION OF UNMET NEED Costs per Year Tuition and Fees Room and Board Miscellaneous Expenses Books and Supplies Meals Other Other TOTAL ANNUAL COLLEGE COSTS _ Contributions per Year Expected Family Contribution Expected Student Contribution TOTAL ANNUAL CONTRIBUTION $( ) Financial Aid Awarded (Grants, Loans, scholarships, etc.) HOPE Scholarship Pell Grant FSEOG Grant Stafford Loan State Aid ROTC Scholarship Scholarship Scholarship TOTAL AID AWARDED UNMET NEED (subtract total annual contributions and aid from total costs) $( )

4 OTHER FINANCIAL INFORMATION Please discuss any special circumstances you want to have considered in this application. I certify that this is a true and complete statement of the finances available for my studies. Georgia 4-H reserves the right to require proof of the resources stated above, if necessary, to verify the financial need. Signature of Applicant Signature of Parent/Guardian

5 Georgia 4-H S.A.F.E. Application Complete ONLY if you wish to be considered for Georgia 4-H S.A.F.E. scholarships. Please complete this form and attach to your application. Please limit explanation to the space provided. SCHOLARSHIP AREA Archery Pistol/Rifle Shotgun SCHOLARSHIP ELIGIBILITY To be eligible for a Georgia 4-H S.A.F.E. Scholarship, applicants must be an active graduating senior 4-H member in the 12 th grade and have applied to a creditable, university, or technical institute for the coming year. In addition, applicants must meet the following minimal requirements: 1. Participated in Project S.A.F.E. on the county level for at least two years as a high school student. 2. Applicant must be currently enrolled in the county 4-H program. 3. Applicant must show involvement in the 4-H program outside of Project S.A.F.E. events and activities. 4. Applicant must demonstrate involvement in citizenship and leadership activities. PROJECT S.A.F.E. INVOLVEMENT Activity Year(s) Participated

6 Georgia 4-H S.A.F.E. Applicant Statement of Experience and Impact Highlight Your S.A.F.E. Experience Impact

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