2016 TEXAS 4-H COLLEGIATE SCHOLARSHIP APPLICATION
Deadline for Submission: FEBRUARY 26, 2016
The Texas 4-H Youth Development Foundation provides a limited number of collegiate scholarships to students who are currently enrolled in a Texas College or
University. These scholarships are awarded to deserving former 4-H members who have continued to excel in both academics and service at the collegiate level.
Scholarships typically range from $1,500 to $1,800 and are sponsored by various donors throughout Texas. Some donors do require certain criteria to be met, in order
to be awarded one of their scholarships. See below for a complete list of scholarship eligibility and donor criteria.
SCHOLARSHIP ELIGIBILITY
To be eligible for the Texas 4-H Youth Development Collegiate Scholarship, you must:
1. Be a United States citizen. If the applicant’s transcript reflects a place of birth other than the United States, proof of naturalization must be provided with the
scholarship application.
2. Be a Texas resident.
3. Complete the 2016 Texas 4-H Collegiate Scholarship Application, printed on regular white paper with no smaller than 10 point Times Roman font.
4. Have been an active 4-H member in the Texas 4-H Youth Development Program during high school career.
5. Be attending an accredited, not-for-profit Texas college or university.
6. Have been graduated from high school at least one year prior to time scholarship payments are initiated in the Fall 2016.
7. Have successfully completed or will have successfully completed thirty (30) semester hours of undergraduate college work by the time scholarship payments are
initiated in Fall 2016.
8. Be carrying a minimum of a 2.7 cumulative GPA for course work completed as of the date of the application.
9. BE PRESENT at the 2016 Texas 4-H Roundup Scholarship Orientation, Awards Assembly, and donor banquet in order to receive a Collegiate 4-H Scholarship. If
you believe there are exceptional or extenuating circumstances, which preclude you from attending these events, you may submit a written appeal with the State
Leader for 4-H Youth Development by May 27. All exceptions must be approved by the Texas 4-H Youth Development Program and the Texas 4-H Youth
Development Foundation.
CRITERIA FOR PARTICULAR SCHOLARSHIPS BASED ON DONOR REQUIREMENTS
Texas 4-H Friends and Alumni Association

Current member of the Texas 4-H Friends and Alumni Association

Completed two years at a Texas College/University

Currently enrolled as a full-time student.
Producer’s Cooperative Association of Bryan, TX
 Limited to a geographical region of the following counties: Austin, Bell, Brazos, Burleson, Falls, Grimes, Lee, Leon, Limestone, Madison, Milam, Montgomery,
Robertson, Walker, Waller, & Washington.
 Active member of the Texas 4-H Youth Development Program for at least three (3) years.
 Applicant must come from an agricultural background as demonstrated in the application.
 Applicants from the Blinn College System will be given first priority, if no applicant from Blinn is received, other college/university applicants can be considered.
SCHOLARSHIP APPLICATION EVALUATION
Scholarship awards will be based on:
 Financial need as demonstrated in application.
 Scholastic ability/achievement.
 4-H participation.
 4-H and collegiate leadership and involvement.
SCHOLARSHIP APPLICATION DEADLINE
The completed application, with a copy of your college transcript(s) attached by a staple, must be forwarded directly to the Texas 4-H
Youth Development Office at the address below. Scholarship application must be mailed to the address below and postmarked no later
than the deadline.
DEADLINE: February 26, 2016
Texas 4-H Youth Development Program
c/o Collegiate Scholarship
4180 S Highway 6
College Station, Texas 77845
(Notification of application status will be announced after May 11, 2016)
INSTRUCTIONS
Complete the application as completely as possible in the space provided according to the following page schedule - please do not add pages or write on the reverse side
of any page. A copy of your college transcript(s) listing all undergraduate course work completed must be attached to the application for submission.
Personal Data ............................................................................................................................................................................................................................................ Page 2
College/University/Career Information ..................................................................................................................................................................................................... Page 2
Application Certification........................................................................................................................................................................................................................... Page 2
Family Information ................................................................................................................................................................................................................................... Page 3
Financial Information................................................................................................................................................................................................................................ Page 3
4-H Career ................................................................................................................................................................................................................................................ Page 4
Collegiate Activities........................................................................................................................................................................................................................... Page 4 & 5
College Transcript(s) (does not have to be an official copy, however, if any questions arise, an official transcript will be requested) ............................................. Attachment
1
2016 TEXAS 4-H COLLEGIATE SCHOLARSHIP APPLICATION
PERSONAL DATA
County Where You Were A 4-H Member:
Extension District Number (1 – 12):
Last Name:
First Name:
Middle Name (no initials):
Nickname/Preferred Name (if applicable):
Phonetic Spelling of Full Name:
Gender:
Mailing Address:
City:
State:
TX
Zip:
Home Phone Number:
Cell Phone Number:
E-mail Address:
Date of Birth:
Are you a citizen of the United States? (Yes/No):
Are you a Texas resident? (Yes/No):
Number of years you were in 4-H:
Are you a current member of the Texas 4-H Friends and Alumni
Association? (Yes/No):
COLLEGE/UNIVERSITY CAREER
College/University/Technical School Name you are attending:
Major/Course of study chosen for Baccalaureate Degree/Technical Certification:
Department/College in which this major is offered:
What is your preferred career choice?:
Overall GPA
Total Hours Completed
Number of Semester from Graduation
Anticipated date of Graduation
APPLICATION CERTIFICATION
I certify that the information contained herein is correct and truthfully reflects my personal, 4-H and academic background and records. I agree that, if any information
contained herein is found to be falsified in any way, my application will automatically become null and void. I hereby authorize any person, firm or entity to release to
the Texas 4-H Youth Development Program, or the scholars donor, information concerning the subject matter of the statements I have made in this application,
including, but not limited to, information concerning my academic record, activities, honors and awards, citizenship or residency, and financial situation. A copy of this
authorization is agreed by the undersigned to have the same effect and force as an original. Any person, firm or entity releasing matters pursuant to this authorization is
hereby absolved from any liability.
Signature of Applicant
Date
2
FAMILY INFORMATION
What is your Father/Guardian’s Occupation?:
What is your Mother/Guardian’s Occupation?:
Please explain if you live with a guardian, grandparent, or
have other living arrangements that would be beneficial to
your application:
Please list the name of the County Extension Agent who the
majority of your 4-H career was under?:
Sibling Information
During your college career, how many siblings will also be attending college?
FINANCIAL INFORMATION
Expected College Cost and Personal Savings
College Cost
Tuition per semester hours:
$
Books & fees per semester:
$
Housing per Semester:
$
Are you living in a dormitory? (Yes/No):
Food per semester:
$
Recreation and travel per semester:
$
Name of Donor/Name of Scholarship or
Loan You Currently are On or Have
$/Year
# of Years
Total
Amount
Origination Date
In each of the categories listed below, indicate the amount of assistance you expect to continue to have to pay your college expenses
each semester if you do not receive this scholarship.
Scholarships
Loans
Parents
Personal Assets
Work
Other
TOTAL
Briefly state why you need additional financial assistance and why you should receive this scholarship (minimum of 10 point font and
do not add pages).
3
4-H CAREER
No. of Years Enrolled
Name of 4-H club(s)
List the four most significant 4-H projects during your 4-H career.
Year(s)
Project Title
Activities Related to this Project
List the five most significant 4-H leadership and citizenship activities during your 4-H career.
Year(s)
Activity
Your Function Relating to this Activity
List the five most significant 4-H achievements or honors you received during your 4-H career.
Year(s)
Achievement/Honor
Club
County
District
State
National
COLLEGIATE ACTIVITIES
List four collegiate activities and leadership responsibilities (include social and service clubs, sororities/fraternities, church, campus committees, etc.)
Year(s)
Organization Name
Office/Committee/Leadership Role
Leadership Responsibility
4
COLLEGIATE ACTIVITIES SUMMARY
Please provide in the space below a brief summary of your college career including your involvement in organization(s), success in
your major area, awards/honors, and/or challenges faced and overcome.
5