A complete first-year application shall include:
1. A completed application form which includes a summary of 4-H activities and is verified
by a parent, guardian, or a 4-H leader and the Allegany County 4-H Extension Educator.
2. A recommendation by a 4-H leader.
3. A recommendation from a teacher or a school counselor.
4. Picture of self.
5. The most current transcript grades. If current semester grades have not been received at
time of application, prior semester grades must be submitted.
6. Certification of semester hours enrolled for next semester. A minimum of 13 hours is
required.
7. Signature of parent or guardian will be required for applicants under the age of 21.
Mail completed applications to:
Allegany County 4-H
One Commerce Drive
Cumberland, MD 21502
ALLEGANY COUNTY 4-H SCHOLARSHIP FUND
APPLICATION FOR ORGINAL GRANT
Office Use Only
Amount
Date
Currently participating in 4-H: Yes____ No ____ Years in 4-H:
Name:
Male: ____ Female: ____
Home Address:
Home Phone:
Email:
Date of Birth:
Age as of January 1 this year:
Father's Name and Address:
Living:
Father's Occupation:
Mother's Name and Address:
Living:
Mother's Occupation:
Number of Brothers and Sisters:
Parent/Guardian Phone:
APPROVAL OF THIS REPORT
We have reviewed this report and its attachments and believe them to be correct.
Date:
Signed:
(4-H Member)
Date:
Signed:
(Parent or Guardian)
Date:
Signed:
(Local 4-H Leader)
Date:
Signed:
(County Extension Educator)
RECOMMENDATION: Please have a letter of recommendation from your 4-H leader and a
teacher or counselor sent to Allegany County 4-H, One Commerce Drive, Cumberland, MD
21502.
Due June 1.
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Academic Information:
College:
Number of Years:
Major:
1. Name and address of high school:
2. Name and address of college:
3. Described why you are interested in pursuing a college education:
4. Field in which you are majoring or plan to major:
5. Outline your reasons for choosing this field of study:
Financial Information:
1. List anticipated college costs for the next year:
Tuition Fees $
Board $
Lab Fees $
Books $
Room $
Clothing $
Personal Expenses $
Transportation $
Other:
2. Other scholarships received:
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Awards
1. Major 4-H awards received:
Year
Type of Award
For What Received
Level
2. Major 4-H offices held (club, county, district, state, collegiate):
Citizenship/Leadership Experience
List in chronological order your 4-H citizenship/community service experiences; include things
that contributed to the welfare of your club or group members, other individuals, or community
and indicate the size and scope of what you did.
Citizenship/Leadership Experience Other Than 4-H:
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Career Pathing
Write a brief summary of how your decision to apply for this particular scholarship was (1)
influenced by your 4-H experiences and (2) impacts upon your choice of a career. "How 4-H has
helped me and how this scholarship can help my career plans and aspirations."
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