Return To: University of Illinois Extension

Return to: University of Illinois Extension DuPage County Office 1100 E Warrenville RD - Suite 170 Naperville, Illinois 60563 Attention: 4-H Scholarships

2018 DuPage County 4-H Foundation SCHOLARSHIP APPLICATION

Your completed application must be filled out in full and received at the above address by 6:30 p.m., Monday, May 7, 2018. An incomplete or late application will NOT be considered.

1. Applicant’s Name: (Please print full name) Address:

City, State, ZIP:

Telephone Number:

Date of Birth:

Name of parent(s)/guardian(s):

Address:

Telephone Number: ( )

Email address: ______2. High School Graduation: 2018 2017

Name of High School:

Address:

Telephone Number: ( )

Guidance Counselor Name:

Guidance Counselor Phone:

Other schools attended (if any):

3. Have you applied and been accepted to a College/Trade School? Yes No Name of school:

Address:

Town, State, ZIP:

Field in which you plan to major:

How many credit hours per quarter/semester will you be taking? What are your future career plans?

4. Practical or Work Experience: List all jobs (paid/unpaid) held since the age of 15, including work at home for parents and part-time employment while in school. Begin with the most recent:

Dates Held Job/Position Held Employer/Address

5. Record of 4-H Club Work: (attach additional sheet, if needed) Number of years enrolled in 4-H: Club Name:

Number of years in DuPage Co. 4-H (4 years minimum required):

Total years as a Junior Leader: Offices held in local club: Other leadership activities in club:

Special 4-H awards received:

Special 4-H trips, conferences, etc., attended at Regional, State, or National level:

6. Project Summary: List below the MAJOR projects you have enrolled in during your 4-H membership: (attach additional sheet, if needed)

A. Project: No. of years enrolled

Community Service, Citizenship and Leadership Activities Related to Project:

Recognition related to project (medals/trophies, State Fair delegate, etc.):

B. Project: No. of years enrolled

C. Project: No. of years enrolled

7. Other 4-H Activities: List your participation in demonstrations, talks, radio, and TV appearances, newspaper articles written, tours, camp, judging events, etc. List other leadership experiences, such as camp counselor, junior superintendent, county program committees, etc. (attach additional sheet, if needed)

8. Other Activities (NOT 4-H): List activities, accomplishments, and leadership experiences (religious, school, other youth groups, etc.) (attach additional sheet, if needed)

9. References: List the names, addresses, and occupations of two (2) people you have asked for references, one of whom MUST be or have been your 4-H leader. The reference letters are to be returned with this application. Name Address Occupation

Signatures: Date (Signature of Applicant)

Date (Signature of Parent/Guardian)

PLEASE NOTE:

Attach your 4-H Story, not to exceed two pages (8½” x 11” paper). Try to convey how your participation in 4-H:  contributed to your self-respect and concern for others; and  influenced you in school, your use of leisure time, and career plans.

You may wish to include special interests and unusual situations you encountered and some things you tried, successfully or unsuccessfully. Include how 4-H helped you learn things you didn’t know before.

To be complete, your application MUST include the following:  your 4-H story  letter of application to and/or letter of acceptance from an accredited college or trade school (or proof of enrollment, if you are already attending college)  two reference letters, one of which MUST be from your 4-H leader