PLATTE COUNTY 4-H SCHOLARSHIP APPLICATION

Attach color or black/white photo of yourself.

(Photo required for possible publicity purposes.)

SECTION A. Biographical Data

Name:______________________________________________________Male:____ Female:___

Home Address:_________________________________________________________________

Home Phone: (____)______________________ Social Security No.:______________________

Birth Date: ________________ Age (as of January 1): _________________

College, Trade School or Other Post-Secondary Educational Facility that you plan to attend:

______________________________________________________________________________

Possible major areas of study: _____________________________________________________

Parents or Guardians Names: ______________________________________________________

I prepared this application myself and certify that the information enclosed is true and accurate.

Date: ______________ Signature of 4-H Member: ____________________________________

We reviewed this application and believe it to be correct.

Date: ______________ Signature of Parent/Guardian: __________________________________

On the remaining pages of the application, head each section by letter and name.

Example: SECTION B. Projects

SECTION B. Projects (1 page maximum) List all the projects you have completed as a 4-Her.

SECTION C. Leadership, Citizenship and Community Service (1 page maximum) List all of

the above done as a 4-Her. Be as specific as possible.

SECTION D. Other 4-H Activities and Awards (1 page maximum) Be as specific as possible.

SECTION E. 4-H Story (1 page maximum) What has 4-H meant to you. Emphasize your

personal growth and development.