4-H SCHOLARSHIP APPLICATION FORM
$100 College Scholarship
ALBERT HALL & GEORGE E. HALL SCHOLARSHIP
Qualifications:
Current 4-H member who is attending college in the fall.
2/3 of family income from farming - Scholarship can only be won once.
COUNTY_________________
YEAR______________
1.
First, middle and last name_______________________________________________________________
2.
Age on September 1, of this year_________________________________Month, Date, Year of birth
3.
RESIDENCE:
A. Home Address__________________________________________________________________
_____________________________________________________Zip Code__________________
4.
B.
Home Telephone Number________________________________
C.
Place of residence....Check one: _________Urban
SCHOOL:
A. Year in School......
_________College
________Rural
________Freshman
_______Sophomore
Major__________________________________________________
B.
Name and address, college or trade school you are now or will be attending:
_____________________________________________________________________________
___________________________________________________Zip Code___________________
C.
Name and address of High School attended:
_____________________________________________________________________________
___________________________________________________Zip Code___________________
Scholastic Average __________out of ________points ranked________in a class of _________
5.
FAMILY:
A. Name of parents________________________________________________________________
Address_______________________________________________________________________
Occupations___________________________________________________________________
B.
6.
Number of brothers______________
Number of sisters_____________
Describe why you are interested in pursuing a college education:
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
7.
Field in which you are majoring or plan to major:___________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
8.
Outline your reasons for choosing this field of study:_________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
9.
List anticipated college costs for the next year:
Tuition fees
$_______________
Board $______________
Lab Fees $______________
Personal Expenses $_____________
Room $______________
Books $________________
Clothing $________________
Transportation $_____________
Other $______________
_________________________________________________________________________________
10.
Your completed 4-H records will detail your 4-H activities. In the space provided, highlight your 4-H
participation.
A.
Number of years enrolled as a 4-H member___________________
B.
Major projects _______________________________________________________________
C.
Major 4-H honors received______________________________________________________
____________________________________________________________________________
____________________________________________________________________________
D.
Major 4-H offices held__________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
E.
Special 4-H activities____________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
11.
On a separate sheet of paper, briefly describe what 4-H means to you and how it will help you in college
and in the future.
APPLICATIONS ARE DUE WITH YOUR COMPLETED 4-H RECORDS
I have personally prepared this application and believe it to be correct.....
Date_______________________
_______________________________________________
Signature of applicant