To: Current High School Senior 4-H Members
From: Margaret Schmid, 4-H Foundation Chairperson
Re: DeWitt County 4-H Foundation Scholarship
Date: September 2009
Attached is the DeWitt County 4-H Foundation scholarship application. Please note that you are to submit your cumulative DeWitt County 4-H Member Record.
If you do not have a record form, please contact the Extension office at 217/935-
5764.
Scholarships are $500 each. Scholarships are not required to be awarded annually by Foundation.
If you have any questions, please call Sherry Fulton at the Extension office.
The scholarship deadline is March 12, 2010. The application and all supporting materials must be submitted by 4:00 p.m. on this date. Check the list to make sure you have all materials: application form; 4-H Member Record; 4-H story; two reference letters; and proof of acceptance to an accredited school, college or training center for fall 2010. One reference letter is to be from your 4-H club leader.
The scholarship committee will conduct interviews the morning of March 20,
2010.
Enc.

1. Eligibility
 current high school senior
 currently enrolled DeWitt County 4-H member by January 1, 2010
 traditional 4-H club member in DeWitt County for four years
 proof of acceptance to an accredited school, college or training center for fall 2010
2. The scholarship will be awarded on a combined basis of merit and 4-H accomplishment,
4-H records, interview and references.
3. The recipient may enter any college or technical school of their choice in any degree program.
4. Payment: The first payment of $250 will be paid after the Extension office receives proof of acceptance for schooling. The second payment of $250 will be made after the Extension office receives a copy of grades showing good standing from the first semester studies and proof of returning to school second semester. The total scholarship is $500.00.
5. References: Ask the individuals to complete the reference form put it in a sealed envelope. The envelope should then be attached to the application when you submit it. Candidates are to have two references. One reference is to be from your 4-H leader.
6. The scholarship winner/winners will be introduced at the DeWitt County 4-Hfair awards program in July.
7. Applications and materials are due by March 12, 2010, 4:00 p.m. Return your application to the
University of Illinois Extension, DeWitt County, 4-H Foundation, 8425 Katie Rd., Clinton, 61727.
8. Scholarships do not have to be awarded annually by the Foundation.
9. The Foundation board requests the scholarship winner/winners display their records and memorabilia at the 4-H fair to encourage other 4-H members to set their goals for achievement.
10. The Foundation board may contact a scholarship winner to speak at the 4-H achievement program or other events.
The DeWitt County 4-H Foundation scholarship award committee will use the following scoring system to determine the scholarship winner/winners.
 maximum of 40 points for 4-H records - DeWitt County 4-H Member Record Form
 maximum of 35 points for 4-H accomplishments
 maximum of 15 points for the interview
 maximum of 10 points for 4-H story

11. Summary of materials to be submitted:
 4-H Foundation scholarship application
 Two reference forms to be attached (in sealed envelopes) to application by March 12
 DeWitt County 4-H record
 4-H story (What your entire 4-H career has meant to you)
 A letter with proof of acceptance to an accredited school, college or training center for fall 2010.
12. Additional pages may be used as needed to complete any area of the application/materials.
13. Interview date with scholarship committee is set for Saturday, March 20, 2010.
Dated: September 2009

Name
Enrolled by January 1, 2010 in DeWitt County 4-H club: Yes
Year
No
Years in 4-H:
Name you want used in publicity:
Home address:
School address:
Home phone number: (
Social Security Number:
Age January 1 this year:
Parents/Legal Guardians:
Father’s name & address:
Occupation:
Mother’s name & address:
)
Date of last enrollment:
(print)
Zip code:
Zip code:
Date of birth
Occupation:
Name & address of school you will attend this fall:
What career do you plan to follow?
I personally have prepared this report and certify that it accurately reflects my work.
Date: Signature of 4-H member
We have reviewed this report and believe it to be correct.
Date: Signed
(Parent or Guardian)
Date: Signed
(4-H Leader)
/ /

4-H Foundation Scholarship Application - page 2
1. What are your reasons for choosing to pursue an education beyond high school?
2. In what field are you majoring or planning to major in and why?
3. Major 4-H projects. (List 4-H project areas in which you have enrolled and completed projects. State the number of years you were enrolled in each project.)
4. Major 4-H project awards. (List major project awards and recognition you have received in 4-H -- local, county, state, national.)
Year Project Award Level
5. Project related accomplishments. (What do you think are your most significant project related accomplishments and project related involvements.)

4-H Foundation Scholarship Application - page 3
6. Major 4-H awards and honors. (List awards which are not listed as 4-H project awards in question four, such as the I Dare You Award, Key Award, etc.)
Year Type of Award For What Received Level
7. Major 4-H offices held. (List 4-H offices held, including club, county, district, state.)
8. Major community activities. (List citizenship/community service activities. Include those things which contribute to the welfare of your community, other individuals, or organizations in which you are a member.)
9. What is your fondest memory of 4-H?

2.
3.
4.
Citizenship
1.
2.
Name of Applicant
Name of Evaluator
Position or Title
Address
(city, state & zip)
Please rate the applicant according to the following scale:
(0 unknown and 1 poor to 5 excellent)
Leadership & Teamwork
1. Works effectively with everyone in a group.
0 1 2 3 4 5
Communicates ideas effectively.
0 1 2 3 4 5
Takes responsibility and follows through.
0 1 2 3 4 5
Contributes a fair share of work to a group effort.
0 1 2 3 4 5
Participates in community service activities.
0 1 2 3 4 5
Works well with diverse audiences.
0 1 2 3 4 5
(over)

Interpersonal Skills
1. Gets along well with others.
0 1 2 3 4
2.
3.
Has a positive attitude.
0 1 2 3 4
5
5
Displays respect for ideas of others.
4.
0 1 2 3 4 5
Uses good judgement when opposed to ideas or projects.
0 1 2 3 4 5
In the space provided please offer any additional comments regarding the applicant.
How do you know the applicant? (i.e. teacher, 4-H leader, etc.)
Signature of Evaluator
Date
Please place in a sealed envelope and return to applicant to submit with application.