4-H Foundation Round up Scholarship

4-H Foundation Round Up Scholarship APPLICATION FORM (Must be 13 yrs. of age by January 1 of the current calendar year & completed the 7th grade.)

A 4-H Foundation Scholarship is earned by active participation in events and leadership roles. Use this application form to record your participation.

The Cleveland County 4-H Foundation will fund partial scholarships ($75 e ach for the first 10 students). Earn 100+ to receive a scholarship. 4-H’ers with 100 points or less m ay receive partial scholarships if funds are available.

Name: Club:

Address City: Zip:

Age: Birthday: Phone:

Parent's Signature Leader’s Signature

ACTIVITY OR EVENT POSSIBLE POINTS MY POINTS

Submit a record book at County Level in 2014-2015 Placing 15 pts. Submit a r e c o r d book at S ta t e l e v el i n 2014-2015 10 pts. Submit a form for County 4-H Medals 5 pts. County Fair Exhibits 2014-2015 List Exhibits & Placing: 2 pts. each

Maximum 20 State Fair Exhibits in 2014-2015 List Exhibits & Placing: 2 pts. each

Maximum 20 Participated in County Share- The-Fun 5 pts. Exhibited in County Healthy Living Fair List Exhibits & Placing: 2 pts. each

Maximum 10 Participated in 4-H Public Speaking Event List category & Placing 10 pts. each

Maximum 20

Fun Fest: specify Leadership provided - List:

5 pts . Served as Teen Leader for Summer Day Camp Programs 3 pts/day Attended Youth Action Conference 5 pts. Camp Counselor 10 pts. Served as Ambassador 10 pts. Radio or TV appearance promoting 4-H 5 pts. each Enter local Spring Livestock and/or Horse Show /Dog Placing: 5 pts.

Enter Co. Spring Livestock and/or Horse Show/Dog 5 pts. Placing:

Enter State Spring Livestock and/or Horse and/or 4-H Sanctioned Dog Show 5 pts. Placing:______Participated in Spring Fun Fair or Appropriate Dress

5 pts. each Maximum Placing: 10

Big 3/Livestoc k Field Days: 5 pts. Total number participa ted in:

Placing: Judging Contests entered: List 5 pts. 4-H Offices held and committees 5 pts. served on in 5 pts. 2013-2014 5 pts. Club 2 pts. County each District- Maximum State 10 Committ ees

Number of local 4-H meetings attended

2pt. each-Max.20

4-H Workshops, short courses, training attended (Does not include individual Round- up workshops, speech club, CPR, etc.) List: 2 pt s . each Maximum 4-H Workshops, 20 short courses, tours organized and held - List: 3 pt s . each

e Organizations belong to and offices held in school, church, tc. List:: M a x i m um 15

2 pts. each Maximum 20 Other 4-H Events and/or

Community Service

participated in: List: 2 pts. each Maximum 20 Bonus Points

(complete if you need pointWsr)ite a paragraph and attach to this form

Maximum 25

on "What 4-H Means to Me and My Goals and Desires for 4-H Next Year." TOTA POIN

For additional space, attach separate sheets.