Cooperative Extension
in Schuylkill County
1202 Ag Center Drive
Pottsville, PA 17901
(570) 622.4225
Fax: (570) 622.4481
E-mail: schuylkillext@psu.edu
Schuylkill County Outstanding 4-H Member Application
Dear 4-H Member:
Congratulations on your 4-H involvement! In order to ensure that you will have the opportunity to be
recognized for your achievements, please read the following information before you fill out the application.
 Outstanding 4-H Member Awards may be given out in three age groups: 8-12, 13-15, and 16-18. Please
check the appropriate age category on application to indicate your age group. All age groups are based
on 4-H age (age as of January 1 of the current year).
 Your responses to all questions must be written neatly or typed. All questions must be completed before
the application will be considered for recognition.
 The application must be signed by you (the applicant) and a Schuylkill County Extension Educator
before it will be considered for recognition.
 You MUST include a letter of recommendation from your 4-H leader. This letter should detail your
4-H involvement and your worthiness for the award. Letters must be sealed and attached directly to the
application. It is up to you, the applicant, to request a letter from your leader! A letter IS required!
 On the application, you must choose only one category in which you wish to be considered for the
Outstanding 4-H Member Award. That category may be 1.) A specific project area (choose one of your
current projects, such as entomology, vet science, horses, or market goats); or 2.) Leadership
concentration.
 The Extension office and the contest judges reserve the right to designate an Outstanding 4-H Member
only in those categories where they feel a deserving applicant has applied and award $25 to each
recipient. (In other words, even if several 4-H’ers apply for the Senior Outstanding Horse Member
Award, if the judges feel that no worthy candidate has applied, they may choose not to select an
Outstanding Horse Member for the year.) Likewise, the extension office and the contest judges reserve
the right to recognize more than one outstanding individual in each category. If there is only one
applicant for a particular category, an award may or may not be given, depending on the strength of the
application.
Application deadline postmarked by October 31st of each calendar year or delivered to the
Schuylkill County Extension Office by 4:30 PM, October 31st.
Good luck to all!
Revised 9/24/07 by the Schuylkill County 4-H Development Board Scholarship Committee
College of Agricultural Sciences
Penn State, U.S. Department of Agriculture, and Pennsylvania Counties Cooperating
An Equal Opportunity University
Schuylkill County Outstanding 4-H Member Application
Name (first, middle, last): ________________________________________________________
Social Security Number: _________________________________________________________
Home Address: _________________________________________________________________
Home phone: Area code _________________ phone: __________________________________
Email: ________________________________________________________________________
Birth Date: ________________________ Age as of Jan 1 this year: _______________________
Sex: _____ M
_____ F
Years in 4-H: ____________________________________
Name of your 4-H club or group: ___________________________________________________
Check which age category you are applying for:
_____ Junior (8-12)
_____ Intermediate (13-15)
_____ Senior (16-18)
Check which topic category you are applying for:
_____ Project Specific (list your project) ____________________________________________
_____ Leadership Concentration
_____ Both categories (You may only receive one scholarship but will be considered in each
scholarship review).
Have you applied previously for these awards? __________
If yes, which category? __________________________________________________
Have you previously won one of these awards? __________
If yes, when were you awarded the Outstanding 4-H’er Award and in what amount?
________________________________________________________________________
What activities other than 4-H do you participate in?
______________________________________________________________________________
1. List all activities, committees, competitions, special awards, and/or recognition related to your
chosen project or leadership concentration. List only those you participated in/received this year.
Give a brief description of your role at each event. (Ex: “County Round-Up- won Hunter Over
Fences, helped younger members prepare for Grooming and Showmanship”, or “PA Farm Show-exhibited the first place Suffolk yearling ewe.”) Be sure to include project and record books you
completed in the list. (Bullet format may help)
2. Leadership:
a. Leadership roles (if applicable; include brief descriptions for any listed): Ex: “teen leader,
organized 4-H movie night, organized club picnic, met six times with a new member to
teach fitting and showmanship skills, helped teach a new member the 4-H Pledge at a
meeting”.
b. Describe your two most important 4-H related leadership experiences from the current year.
Consider your club or county offices held, camp counselor positions, teen leadership
activities, etc.
3. Describe your most important community service experience from the current year. Why was this
experience meaningful for you?
4. Describe your most important 4-H related communications experience from the current year.
Consider public speaking contests and demonstrations to club members, etc.
5. Describe the two most important things you have learned from your 4-H projects this year.
6. Write a paragraph about why 4-H is important to you. Think about why you joined 4-H, what you
like about 4-H, what you have learned at 4-H events, what your 4-H leaders and friends mean to you,
and why you would tell others to join 4-H.
How Applications Will Be Scored
Growth through 4-H Projects and Activities ……………………………………………..20 points
Growth through 4-H Leadership….………………………………………………………20 points
Growth through 4-H Citizenship and Community Service ...…………………..………...20 points
Growth through 4-H Communication …………………………………………..………..20 points
Personal Growth and Development through 4-H …………………………………...……20 points
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.
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: ___________________________________________________________________
Revised by Development Board Scholarship Committee September 24, 2007
The Pennsylvania State University is committed to the policy that all persons shall have equal access to programs, facilities, admission, and employment
without regard to personal characteristics not related to ability, performance, or qualifications as determined by University policy or by state or federal
authorities. It is the policy of the University to maintain an academic and work environment free of discrimination, including harassment. The Pennsylvania
State University prohibits discrimination and harassment against any person because of age, ancestry, color, disability or handicap, national orientation, race,
religious creed, sex, sexual orientation, or veteran status. Discrimination or harassment against faculty, staff, or students will not be tolerated at The
Pennsylvania State University. Direct all inquiries regarding the nondiscrimination policy to the Affirmative Action Director, The Pennsylvania State
University, 328 Boucke Building, University Park, PA 16802-2801.
Tel. 814-865-4700/V.
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 Briana L. Shealer at 570-622-4225 in advance of your participation or visit.