The Schuylkill County 4-H
Scholarship
Application
Schuylkill County 4-H Scholarship Form Guidelines
NAME: The name of this scholarship shall be the “Schuylkill County 4-H Scholarship”,
sponsored by the 4-H Development Fund.
PURPOSE: The purpose of this scholarship shall be to provide financial assistance for
continuing education, to help develop youth potential, and to recognize that the
dedication of 4-H volunteers has impact on the lives of youth.
ELIGIBILITY: Applicant must be a high school graduate. Applicant must have
been a Schuylkill County 4-H member for at least two years. Consideration for this
scholarship shall be given to all current Schuylkill County 4-H members including
alumni up to the age of 22 who are currently enrolled in an education beyond high school
including (but not limited to) college, trade school, or nursing school.
SELECTION PROCEDURE: Recipients of this scholarship shall be selected by
criteria established by the Schuylkill County 4-H Development Board.
AMOUNT OF AWARD: Two (2) scholarships in the amount of $250.00. The
Extension Office and the contest judges reserve the right to designate a scholarship only
when they feel a deserving applicant has applied. (In other words, even if several 4-Her’s
apply, if the judges feel that no worthy candidate has applied, they may choose not to select a
recipient for the year.)
TERM OF AWARD: The scholarship will be paid directly to the recipient. The
recipient is not required to repay the scholarship for any reasons.
AMENDMEND: The Schuylkill County 4-H Development Board shall have the
authority to make any changes in these guidelines which may be necessary to ensure the
fulfillment of the above-stated objectives.
An individual is only eligible for this scholarship one time.
The committee reserves the right to interview applicants.
The committee reserves the right to ask for additional information.
Application deadline postmarked by October 31st of the calendar year or delivered
to the Schuylkill County Extension Office by 4:30 PM, October 31st.
The Schuylkill County
4-H Scholarship Application Form
Name (first, middle, last): __________________________________________________
Name you want used for publicity: ___________________________________________
Home Address: ___________________________________________________________
________________________________________________________________________
Home phone: Area code _________________ phone: ____________________________
Email: __________________________________________________________________
Birth Date: __________________ Age as of Jan 1 this year________________________
Sex: _____ M
_____ F
Are you currently participating in 4-H? _____ Years in 4-H _______________________
Name of your 4-H club or group: ____________________________________________
Name and address of school you are attending: __________________________________
________________________________________________________________________
________________________________________________________________________
I prepared this application and certify that the information in it is accurate.
Signature of applicant _____________________________________________________
Date: ___________________________________________________________________
We reviewed this application and believe it to be correct.
Signature of Parent/ Guardian _______________________________________________
Date: ___________________________________________________________________
Signature of County Extension Educator _______________________________________
Date: ___________________________________________________________________
Have you applied previously for this scholarship? __________
If yes, when? __________________________________________________
Have you previously won this scholarship? __________
If yes, when were you awarded this scholarship and in what amount? ________________
________________________________________________________________________
Section A. Academic Information
High School:
Name and address of last high school attended and dates of attendance:
________________________________________________________________________
Year of Graduation: _______________________________________________________
Academic honors received: _________________________________________________
________________________________________________________________________
________________________________________________________________________
College or Post Secondary School:
Name and address of all colleges and post secondary schools attended and dates of
attendance:
________________________________________________________________________
________________________________________________________________________
Semester completed: ________________________Major:_________________________
Name of Academic Advisor: ________________________________________________
Section B. Financial Information
On separate sheets of paper, answer the questions below. Title each page “Section B.
Financial Information” and attach the pages behind this page of the form.
Question 1. How do you plan to finance your education? Be as specific as you can about
costs, personal and family resources, and your anticipated need for financial assistance.
List any other scholarships you have received, and any educational loans or grants
applied for or received.
Question 2. Are there any special circumstances that will affect your costs or needs for
assistance? (Example: Are brothers or sisters attending post-secondary schools at the
same time or disabilities requiring special equipment or services.) If so, please explain.
Section C. 4-H Project/Activity Experience
On separate sheets of paper, describe your most significant 4-H projects and activities.
Examples of projects include Entomology, Horse, Market Goat, Dairy, Rocketry, and
Cooking. Examples of activities include: participation in demonstrations, talks, exhibits,
and judging events; radio and television appearances; newspaper articles written; field
trips taken; and tours, workshops and camps attended. Title each page “Section C. 4-H
Project/ Activity Experience” and attach the pages behind this page of the form.
Include with your responses:
 List projects and activities you participated in throughout your 4-H career.
 List the skills and types of knowledge you’ve gained through 4-H.
 How has 4-H contributed to your personal growth and influenced your
educational and career choices.
Section D. Citizenship/Leadership Experience
On separate sheets of paper, answer the questions below. Title each page “Section D.
Citizenship/Leadership Experience” and attach the pages behind this page of the form.
Question 1. List in chronological order your 4-H leadership and citizenship/community
service experiences. Include activities you have led or participated in that contributed to
the welfare of your club or group members, other individuals outside your family, or your
community, as well as major 4-H offices you have held (club, county, district, state, or
collegiate).
Question 2. List in chronological order other significant citizenship or leadership
experiences you have had outside of 4-H, in school and in youth, community, or religious
organizations. Include the same types of information in your descriptions of these
activities as you did in your descriptions of 4-H activities in the previous question.
Section E. Career Path
On a separate sheet of paper, answer the question below. Limit your answer to one page,
title it “Section E. Career Path,” and attach it behind this page of the form.
Question: What career path do you plan to pursue when your education is completed?
How did your experiences in 4-H influence your decision to apply for this scholarship,
your choice of a field of study, and your career goals?
How Applications Will Be Scored
Growth through 4-H Projects and Activities.……………………...………..20 points
As shown by knowledge, skills, and insights gained; scope and sophistication of projects
and activities; breadth and depth of participation; development of life skills; and
information shared with others.
Growth through 4-H Leadership….……………………………………..………20 points
As evidenced by offices and leadership positions held at various levels and
accomplishments in leadership roles.
Growth through 4-H Citizenship and Community Service ...…………………...20 points
As demonstrated by the extent of participation in service to individuals, groups, and
communities; and by the development of positive attitudes toward service.
Growth through Leadership, Citizenship, and Activities Outside 4-H ..………..20 points
As indicated by offices and leadership positions held, experience gained, and
participation in service projects in school and in other youth, community, and religious
organizations.
Personal Growth and Development through 4-H ………………………...……20 points
As shown by attitudes, insights, and life skills gained through 4-H projects, experiences,
leadership, and citizenship and service activities; and by clarity and appropriateness of
educational and career choices.
Don’t forget this before submitting application:
 Application form is filled out completely and legible.
 All required signatures are included.
 A leader letter of recommendation signed and sealed must be included.
Penn State encourages persons with disabilities to participate in its programs and activities. If you
anticipate needing any type of accommodation or have questions about the physical access provided, please
contact your local Extension office in advance of your participation or visit.
This publication is available in alternative media on request.
The University is committed to equal access to programs, facilities, admission and employment for all
persons. It is the policy of the University to maintain an environment free of harassment and free of
discrimination against any person because of age, race, color, ancestry, national origin, religion, creed,
service in the uniformed services (as defined in state and federal law), veteran status, sex, sexual
orientation, marital or family status, pregnancy, pregnancy-related conditions, physical or mental disability,
gender, perceived gender, gender identity, genetic information or political ideas. Discriminatory conduct
and harassment, as well as sexual misconduct and relationship violence, violates the dignity of individuals,
impedes the realization of the University’s educational mission, and will not be tolerated. Direct all
inquiries regarding the nondiscrimination policy to Dr. Kenneth Lehrman III, Vice Provost for Affirmative
Action, Affirmative Action Office, The Pennsylvania State University, 328 Boucke Building, University
Park, PA 16802-5901, email: kfl2@psu.edu, phone: 814-863-0471.
Revised by Development Board Scholarship Committee September 24, 2007