LOGAN COUNTY DAIRY SCHOLARSHIP APPLICATION FORM

For an applicant to apply for a Logan County Dairy Scholarship, the following must be submitted to the OSU Extension, Logan County office before March 15 of current year.

1. A completed Logan County Dairy Scholarship Application form (typed or legibly printed).

2. A transcript of official high school grades.

3. A letter of recommendation from a school counselor or academic advisor.

All of the above materials should be compiled by the applicant and bound together.

There will be two (2) $500.00 scholarships awarded by the Logan County Dairy Association with the winners to be announced at the annual Dairy Awards Banquet and paid to the recipient in August of the award year with proof of acceptance to college or trade school.

1. County ______District ______

2. First, Middle and Last Name ______

3. Age on January 1 of this year ______Month, Day and Year of Birth ______

4. Social Security Number ______

5. Residence: A. Home Address ______street town zip B. Home Telephone Number ( ) ______C. Place of Residence (check one) ______Farm ______acres ______Town under 10,000 and open country ______Town or city 10,000 to 50,000 D. School address ______street town zip E. School Telephone Number ( ) ______

6. Family: A. Name and address of father______name address Living: Yes _____ No _____ Occupation ______

B. Name and address of mother ______name address Living: Yes _____ No _____ Occupation ______

C. Name and address of guardian ______name address D. Number of brothers ______Number of sisters ______E. Ages of all brothers ______and sisters ______7. Dairy Experiences: In the spaces provided, explain your accomplishments in the dairy field, the impact dairying has made upon you and your family, what impact you have been able to make (as a result of your dairy work).

A. Number of years in dairying ______(2 pts.) B. Major dairy projects: ______(5pts.) C. Major accomplishments through dairying: ______(8pts.) D. Other leadership experiences: ______(8pts.) E. Special dairy activities and experiences: ______(8pts.) F. Major honors received through dairying:______(3pts.) Points Scored____/34

G. The most important things you have learned through dairying and the impact dairying has made upon your plans for the future: ______(10pts.) 8. Experiences in other groups and activities: In the spaces provided, show your involvement in other groups and in other interests as well as evidence of impact of what you have done.

A. School ______(3pts.) B. Community ______(3pts.) C. Church ______(3 pts.) D. Hobbies ______(2 pts.) E. Special Interests ______(3 pts.) Points Scored ____/24 9. Future plans and potential for success A. Academic preparation I. Year in school _____ High School, Date of Graduation ______Technical or Trade School: Year ______Date of Graduation ______College: Freshman _____ Major ______Sophomore _____ Junior _____ Senior _____ Date of Graduation______Graduate _____ Degree ______

ii. Name and address of high school, college or trade school you are now attending: ______name street town zip

iii. If a high school graduate, name and address of high school attended:

______name street town zip

iv. Scholastic average ______out of ______points. (3 pts.)

v. College, university or trade school attended beyond the high school level: Dates of Credits Name of Institution Attendance Earned Scholastic Average ______B. Describe why you are interested in pursuing a college education:______(7 pts.) C. Field in which you are majoring or plan to major: ______D. Outline your reasons for choosing this field of study: ______(20 pts.)

Points Scored _____/30 E. College or University you plan to attend: ______

10. Need for a dairy scholarship:

A. Explain your need for financial assistance to continue your college education during next year and describe your plans for meeting this financial need. Include your plans for self-support and aid from your family. Mention any special or unusual financial needs. ______(4 pts.) B. List anticipated college costs for the next year: Tuition Fee $______Board $______Lab Fees $______Room $______Personal Expenses $______Books $ ______Clothing $______Transportation $______Other $______(2 pts.) C. Will you have any brothers or sisters attending college or trade school during the next year? Yes ______No ______If yes, explain: ______(2 pts.) D. Have you been chosen or are you being considered for any other scholarships for the next year? Yes _____ No _____ Name of Scholarship Amount Being Considered or Been Chosen ______(2 pts.) E. Will you be receiving or have you applied for any educational loans for the next year? Yes _____ No _____ Loan Institution Name Amount Have Applied or Will Receive ______(2 pts.)

Points Scored /12 I have personally prepared this application and believe it to be correct: Date ______Signature of Applicant

TOTAL POINTS SCORED _____/100