Georgia 4-H Scholarship Application - The Georgia 4-H Foundation

Georgia 4-H Achievement Scholarship Application2012 If you wish to be considered for scholarships that consideryour financial need, please check the following box andcomplete and attach the statement of need. Please attach a one-page, typed resume (10 point font, one-sided, ½ inch margins max.) along with this applicationPERSONAL INFORMATIONNameCountyAge Date of Birth Phone NumberHome AddressEmail AddressYear in CollegeStreet City State / Zip Incoming Freshman Freshman Sophomore Junior SeniorApplicants must summarize, highlighting the information you feel most important for the Scholarship Committee to knowabout you. Do not add extra pages, except for required agent letter, personal statement, resume, and transcript. If youwish to be considered for the scholarships that consider financial need, attach the statement of need. Use only providedspace on application to answer questions. Application must be typed using 12 pt. font.4-H INVOLVEMENTIN ORDER OF IMPORTANCE TO YOU, please list and describe your most significant achievements in 4-H.Please DO NOT attach additional sheets.Years enrolled in 4-H1. Discuss your 4-H Project Work2. 4-H Offices Held and Committees Served On3. 4-H Competitive Events Participated In4. 4-H Camps and Conferences AttendedPage 1 of 5

5. Honors received in 4-H6. Service to Others Through 4-H (Community Service)7. Summarize 4-H Teen Leadership Activities8. What one 4-H Experience has made the greatest impact on your life? Explain why.9. Other Non-4-H Related Activities:Summarize other interests and activities indicating major offices, responsibilities, honors, recognition, etc.List in the order of importance of the significance to you.Please Check All that Apply:Are you currently active in a collegiate 4-H program? Yes NoHave you received a 4-H Scholarship in the past? Yes NoIf yes, please include the name(s) of scholarship(s) received and year(s).Have you mastered in a 4-H project? Yes NoIf yes, please include the area(s) you mastered in, as well as the year(s).Page 2 of 5

EDUCATIONAL STATUSName of College/University at which you have been accepted for Fall 2012. * If you have not received an admissionsdecision, please list the schools to which you have applied. (If UGA, to what School or College did you apply?) Applied Accepted Applied Accepted Applied Accepted Applied Accepted Applied Accepted Applied AcceptedIf you are enrolled in high school, what is your grade point average?Indicate highest SAT/ACT scoresVerbal Math TotalIf you are enrolled in college, what is your grade point average?Please list the field in which you plan to majorTThe following items are required and must be received by the State 4-H Office by the statedapplication due date (March 1, 2012) to be fully considered for all available scholarships:□ SAT/ACT Score (if in high school) □ Name of College Accepted or Applied □List College Major/Career Field□ Official Copy of Transcript □4-H’er Signature □ County Extension Staff/4-H Signature□ Required letter from County Extension Staff/4-H. (Limited to 1 page only)□ Personal Statement prepared by 4-H’er. Use a separate page to tell us about yourself beyond what isalready in your application. You may use your creativity in articulating a response in a way that willhelp the scholarship committee know you better. (Limited to 1 page only, 12 pt. font, double spaced.)□ Statement of Need If you wish to be considered for scholarships that consider your financial need.(Use statement of need provided on page 5 of application)□ Resume (One-page, typed, 10 point font, one-sided, ½ inch margins max.)DateSignature of ApplicantDateSignature of County Extension Staff/4-HPage 3 of 5

Georgia 4-H Achievement Scholarship Statement of Need*Complete ONLY if you wish to be considered for scholarships that review your financial need. Pleasecomplete this form and attach to your application.Please limit explanation to these pages only.Have you or do you plan to file for FAFSA? (Free Application for Federal Student Aid) □Yes □ NoAre you your sole support and will not receive assistance from parent/guardian? □Yes □ NoDetermination of Unmet Need:Costs per year:Tuition and FeesRoom and BoardMiscellaneous ExpensesBooks and SuppliesMealsOther ___________Other ___________$ ____________$ ____________$ ____________$ ____________$ ____________$ ____________$ ____________TOTAL ANNUAL COLLEGE COSTS$_____________Contributions per year:Expected Family ContributionExpected Student Contribution$____________$____________TOTAL ANNUAL CONTRIBUTION$(____________)2012 Financial Aid Awarded (Grants, Loans, scholarships, etc.):PELL$____________SEOG$____________Stafford$____________State Aid$____________ROTC$____________Scholarship__________________ $____________Scholarship__________________ $____________Scholarship__________________ $____________TOTAL 2012 AID AWARDED$(_____________)UNMET NEED (subtract total annual contributions and aid from total costs) $______________Page 4 of 5

Other Financial Information:Please discuss any special circumstances you want to have considered in this application.I CERTIFY that this is a true and complete statement of the finances available for my studies. Georgia 4-H reserves theright to require proof of the resources stated above, if necessary, to verify the financial need.Applicant signature ___________________________________________ Date ______________________________Parent/Guardian signature ___________________________________________ Date _________________________Page 5 of 5