Virginia Beach 4-H Livestock, Inc.
Senior Information Form
All graduating seniors are required to complete this form and write a short narrative.
This information will be used when recognizing each senior at the Awards Banquet.
Name:
Address:
Phone Number:
Parent’s Names:
4-H Information
Total years in 4-H:
Total Years in Virginia Beach Livestock Club:
Please indicate number of years enrolled in each project
Beef
Swine
Sheep
Breeding Sheep
Goat ___ Ham
Poultry
List other 4-H Clubs
List Leadership Positions held in Livestock Club and other 4-H Clubs
4-H All Star?
Year Tapped:
Plans after Graduation
(Please complete appropriate information)
Undecided at this time:
Enter Work Force (name of company if known)
School or University: ______________________________________________________
Degree Desired:
Department: _________________________
Scholarships received: _____________________________________________________
Signature: ________________________________________ Date:
- over-
Senior Information Form:
Page 2
Narrative
Write a short narrative (100 to 250 words) on the impact (influence) 4-H has had on
your life. Choose your own topic or use the following:
- What ‘life lessons’ has 4-H taught me?
- What has involvement in 4-H taught me?
- How has 4-H influenced my career goals?
Narrative should be on separate paper, identified with your name, and signed. Please
attach to this form.
Send completed Senior Information Form with attached narrative to:
4-H Livestock Senior Recognition Committee
Virginia Beach Extension Office
Building 14, Municipal Center
2449 Princess Anne Road
Virginia Beach, VA 23456
Date Due: June 1, of the application year
----------------------------------------------------------------------------------------------------------Senior Scholarships
All graduating seniors or seniors completing their 4-H eligibility will receive a
Scholarship Certificate from Virginia Beach 4-H Livestock, Inc., subject to the following.
To be eligible for the $250 senior scholarship from the Virginia Beach 4-H Livestock, Inc., applicant must
comply with the following requirements:
1.
Student must be Virginia Beach 4-H Livestock Club member and completed at least one livestock
project in 2 of the last 3 years before graduation from high school or last year of 4-H eligibility (4-H
eligibility ends on Dec 31 of 4-Her’s 19th year).
2.
Applicant must enroll in a trade school, technical school, college or university within 15 months of
graduation from high school
3.
Applicant must complete Senior Information Form and write the narrative as directed.
4-Hers will receive a scholarship certificate at the Livestock Awards Banquet. To receive scholarship
check, it is the applicant’s responsibility to notify the Virginia Beach 4-H Livestock, Inc. (through the
Extension Office) with letter of acceptance or document of enrollment from a trade school, technical
school, college or university (as directed on the certificate).
4-H Livestock: Senior Information Form
Revised: December 2013