Penn State Extension – Berks County
The James Haldeman Berks County 4-H Scholarship Fund Application (revised 1/2016)
Scholarships are available for graduating seniors enrolled in post-secondary education who have been
for the past three years and currently are (as of January 1st) members in good standing of the Berks
County 4-H Program, and who best exemplify the fundamental values guiding 4-H members.
Preference will be given to members who remained active in 4-H in the past three years.
To be considered for this scholarship. Complete and submit the form below between January 15th and April 1st.
This application and all required attachments must be submitted by the deadline.
Print the application, complete it, and send it and all required attachments in one envelope to the
following address with a postmark of no later than the deadline April 1st. If you mail in the application,
and if all of the required attachments are not included in one envelope along with your application,
your application will be marked as incomplete and will not be considered. Not exceptions will be made.
The Jim Haldeman Berks County 4-H Scholarship
Penn State Extension – Berks County
1238 County Welfare Rd – Ste. 110
Leesport, PA 19533-9709
Attachments Required:
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A one-page essay on the topic “Why would you encourage a younger child to participate in 4-H?”
A copy of your most recent high school transcript. Transcript can be unofficial.
Three letters of recommendation. One letter must be from a 4-H leader and two letters should be from
individuals who can provide information about you. This letter should be from a teacher, school official,
clergy, employer, advisor, community leader or other person who knows you well.
Applications missing items will be rejected. There will be no follow up to obtain missing items.
Applicant Name:
Prefix First
MI
Last
Date of Birth
Street Address:
Address 2: (optional)
City:
State:
Email Address:
Home Phone Number:
Township/Borough:
High School Name:
Parent(s) Name(s):
Graduation Date:
Zip:
County:
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Post-Secondary Plans:
What educational institute are you planning to attend?
Educational Institution Location:
Have you been accepted?
Yes
NO
Briefly describe the course of study you will pursue:
4-H Involvement
How many years were you a member of 4-H?
Which 4-H Clubs are you enrolled in? Indicate the years you were enrolled in each (example: Berks County 4-H
Club (2009-2016)
Describe the three 4-H activities that had the biggest impact on your 4-H career and why their impact was so
memorable and/or important. (Activities can include club, county, and/or state events or projects.)
Describe the top five 4-H leadership positions you have held over the past three years and how your leadership
skills grew as a result. (Leadership positions can include teen leader, club officer, committee chairperson,
advisory board/council representative, etc.)
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Describe your involvement in community service projects at the club, county, regional and /or state level over
the past three years. (Example: I participated in club visits to Berks Heim (2011, 2014, 2015) where we played
bingo with the residents.)
List the major awards you have received in the 4-H Program over the past three years. Be sure to indicate the
year received. (Example: 2015 Senior Division Record Book Award Winner)
Activities, Awards and Honors
List all school activities (outside of 4-H) in which you have participated in the past three years.
List all community activities (outside of 4-H) in which you have participated in the past three years.
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Indicate all special awards, honors and offices held (outside of 4-H) in the past three years.
List any work experience you have had in the past three years, even if unpaid. (Example: checkout cashier,
Target, Wyomissing – 2015).
_____Please attach a one-page essay with topic “Why would you encourage a younger child to participate in
4-H”
_____Please attach your most recent high school transcript. Transcript can be unofficial.
_____Please attach a letter of recommendation from a 4-H leader.
_____Please attach a second letter of recommendation from and individual who can provide information about
you such as a teacher, school official, clergy, employer, advisory, community leader or other person who knows
you well.
_____Please attach a third letter of recommendation from an individual who can provide information about your
such as a teacher, school official, clergy, employer, advisor, community leader or other person who knows you
well.”