Date Received in Office______
4-H COUNCIL SCHOLARSHIP APPLICATION FORM
Name_________________________________________________________________________
Address_______________________________________________________________________
City_______________________________________________________ ZIP ________________
Club Name ____________________________________________________________________
Event _________________________________________________________________________
Dates _________________________ Location ________________________________________
Cost of event (registration, transportation, other)
______________________________________________________________________________
______________________________________________________________________________
What have you done to prepare for this event?
______________________________________________________________________________
______________________________________________________________________________
Would you be willing to train others as a result of your learning a new idea? How would you do
this?
______________________________________________________________________________
______________________________________________________________________________
What does participation in this program contribute to the overall personal development of
young people?
______________________________________________________________________________
______________________________________________________________________________
How will your involvement in this event affect the local program in your district/state?
______________________________________________________________________________
______________________________________________________________________________
Signature of Applicant:
Requirements for Central Peninsula 4-H Council Scholarship
1.
Be currently active in the 4-H program.
2.
Have been involved with 4-H a minimum of 2 years.
3.
Be committed to continuing as a member/volunteer in 4-H and be available to share
learning with Kenai Peninsula 4-H.
4.
Exemplify outstanding leadership, citizenship, active community service and commitment
to the local and district 4-H programs.
5.
Attend the entire event and learning sessions.
6.
Serve as goodwill ambassadors for 4-H and its services in the community.
7.
Bring the “priceless gift of service and enthusiasm which lightens the load for all”.
8.
Meet with the 4-H Agent before and after the event for sharing of ideas and experiences.
CHOOSE FIVE (5) OF THE FOLLOWING:
____ 1.
Teach a class at Rally Day.
____ 2.
Write a report or newsletter of event to be sent to all leaders of our district and to 4-H
agents in Alaska.
____ 3.
Be available to club leaders and clubs as a resource person.
____ 4.
Give a program to the Central Peninsula 4-H Council.
____ 5.
Write an article on the experience for local media.
____ 6.
Work with schools as a resource person, give classes, using 4-H materials (examples:
gardening, food and nutrition, clothing, photography).
____ 7.
Share experience at State Leader’s Forum.
____ 8.
Work with 4-H Agent in training and encouraging leader development.
“I can meet the above requirements and have checked the five activities I am willing to do upon my return”.
Name _____________________________________________________ Date ____________________