2016 LEADERSHIP SCHOLARSHIP
WYOMING COUNTY
2016 LEADERSHIP SCHOLARSHIP The Wyoming County 4-H Leadership Scholarship is made possible through the generous sponsorship of the Wyoming County 4-H Leaders Association. The purpose of the scholarship is to recognize those 4-H’ers that exhibit a high degree of leadership and community service due to their involvement in the Wyoming County 4-H program. • • • • •
Please use a computer to complete this application. Handwritten applications will not be accepted. Use only the space provided in the application for your responses. Do not add pages. Do not add any additional information not asked for in the application. Do not include resumes. Applications not completed in their entirety will not be considered for an award. A complete application must include three references. References must complete the recommendation forms, which are at the end of this application. Do not include additional letters of reference. Submit a High School Transcript.
Scholarship award amounts will be at the discretion of the scholarship awards selection committee. Eligibility Requirements • • • • •
Applicant must be enrolled in the Wyoming County 4-H program. Applicant must have been a member of the Wyoming County 4-H Youth Development program for at least one year. Applicant must be enrolled or planning to enroll in an accredited university, college or technical school. Applicant must have an average GPA of 80 or better. Applicants cannot have received this scholarship in the past.
Selection Process • • • •
Applicant submits the completed application and references by May 2, 2016. Applications are reviewed by scholarship selection committee members. Applicants are interviewed by scholarship selection committee members the week of May 23, 2016. Scholarship awards will be announced the week of June 6, 2016.
Distribution Procedure • •
•
50% of the scholarship award will be distributed at the 4-H Recognition Dinner in June 2016. 50% of the scholarship award will be distributed upon the successful completion of the first semester. A collegiate or technical school academic transcript for the completed academic term showing a cumulative GPA of at least 2.0 on a 4.0 scale or academic good standing on another scale. A copy of current term fee slip or other document that confirms continued enrollment at the university, college or technical school. Redemption of full scholarship required within one year of being awarded.
The scholarship application and all required materials are to be postmarked no later than May 2, 2016. Wyoming County 4-H 401 North Main Street Warsaw, NY 14569 [email protected]
APPLICATION First Name: Sex (M or F): Zip:
Last Name:
MI:
Street Address:
City:
Home Telephone:
Number of Years in 4-H:
State:
Email Address: Date of Birth:
Father’s/Guardian’s Name: Mother’s/Guardian’s Name: High School from which you will or have graduated or if home schooled: Please describe your plans for next year:
List school activities you have participated in:
What is your anticipated career choice?
2
Current Age:
PERSONAL NARRATIVE List three 4-H projects that have had the most impact on you and why?
What has being a Wyoming County 4-H member meant to you?
3
How do you feel you have grown through your participation in the Wyoming County 4-H program?
Highlight one 4-H event and the impact it has had on you as a person.
4
How have the skills gained in the Wyoming County 4-H program impacted your life outside of 4-H?
How do you plan to give back to 4-H and your community?
- END OF APPLICATION -
5
4-H EDUCATOR RECOMMENDATION This page is designated for one of your 4-H Educators to provide input and remarks for the selection committee regarding your participation in the Wyoming County 4-H program as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
4-H Membership in General:
1
2
3
4
5
4-H Project Work:
1
2
3
4
5
4-H Leadership Roles:
1
2
3
4
5
4-H Community Service:
1
2
3
4
5
County 4-H Activities:
1
2
3
4
5
Total number of years of 4-H participation: How do you feel the applicant has grown as a person through their participation in the Wyoming County 4-H program?
I certify that this applicant has been enrolled in the Wyoming County 4-H Program. I have reviewed the application and I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature:
Date:
ACADEMIC RECOMMENDATION This page is designated for one of your Academic Instructors to provide input and remarks for the selection committee regarding your participation in your school community as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
Scholastic Work:
1
2
3
4
5
School Leadership Roles:
1
2
3
4
5
School Community Service:
1
2
3
4
5
Involvement in School Activities:
1
2
3
4
5
Total number of years you have known the applicant: Does the applicant work to the best of their ability?
How does the applicant demonstrate leadership in the school community?
What is the applicant’s strongest attribute?
I certify that this applicant has been a student in our school community. I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature: School District:
Date:
EMPLOYER RECOMMENDATION This page is designated for one of your Employer’s (either paid or volunteer) to provide input and remarks for the selection committee regarding your participation in your work as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
Work Ethic:
1
2
3
4
5
Work Leadership Roles:
1
2
3
4
5
Commitment to Responsibilities:
1
2
3
4
5
Total number of years you have known the applicant: Does the applicant work to the best of their ability?
How does the applicant demonstrate a strong work ethic?
What is the applicant’s strongest attribute?
I certify that this applicant has been an employee or volunteer at my organization. I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature:
Date:
4-H VOLUNTEER RECOMMENDATION This page is designated for one of your 4-H Volunteer’s (not related to you) to provide input and remarks for the selection committee regarding your participation in the Wyoming County 4-H program as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
4-H Membership in general:
1
2
3
4
5
4-H Project work:
1
2
3
4
5
4-H Leadership roles:
1
2
3
4
5
4-H Community Service:
1
2
3
4
5
Attendance at 4-H activities:
1
2
3
4
5
Total number of years of 4-H participation: How do you feel the applicant has grown as a person through their participation in the Wyoming County 4-H program?
I certify that this applicant has been enrolled in the Wyoming County 4-H Program. I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature:
Date:
2016 LEADERSHIP SCHOLARSHIP The Wyoming County 4-H Leadership Scholarship is made possible through the generous sponsorship of the Wyoming County 4-H Leaders Association. The purpose of the scholarship is to recognize those 4-H’ers that exhibit a high degree of leadership and community service due to their involvement in the Wyoming County 4-H program. • • • • •
Please use a computer to complete this application. Handwritten applications will not be accepted. Use only the space provided in the application for your responses. Do not add pages. Do not add any additional information not asked for in the application. Do not include resumes. Applications not completed in their entirety will not be considered for an award. A complete application must include three references. References must complete the recommendation forms, which are at the end of this application. Do not include additional letters of reference. Submit a High School Transcript.
Scholarship award amounts will be at the discretion of the scholarship awards selection committee. Eligibility Requirements • • • • •
Applicant must be enrolled in the Wyoming County 4-H program. Applicant must have been a member of the Wyoming County 4-H Youth Development program for at least one year. Applicant must be enrolled or planning to enroll in an accredited university, college or technical school. Applicant must have an average GPA of 80 or better. Applicants cannot have received this scholarship in the past.
Selection Process • • • •
Applicant submits the completed application and references by May 2, 2016. Applications are reviewed by scholarship selection committee members. Applicants are interviewed by scholarship selection committee members the week of May 23, 2016. Scholarship awards will be announced the week of June 6, 2016.
Distribution Procedure • •
•
50% of the scholarship award will be distributed at the 4-H Recognition Dinner in June 2016. 50% of the scholarship award will be distributed upon the successful completion of the first semester. A collegiate or technical school academic transcript for the completed academic term showing a cumulative GPA of at least 2.0 on a 4.0 scale or academic good standing on another scale. A copy of current term fee slip or other document that confirms continued enrollment at the university, college or technical school. Redemption of full scholarship required within one year of being awarded.
The scholarship application and all required materials are to be postmarked no later than May 2, 2016. Wyoming County 4-H 401 North Main Street Warsaw, NY 14569 [email protected]
APPLICATION First Name: Sex (M or F): Zip:
Last Name:
MI:
Street Address:
City:
Home Telephone:
Number of Years in 4-H:
State:
Email Address: Date of Birth:
Father’s/Guardian’s Name: Mother’s/Guardian’s Name: High School from which you will or have graduated or if home schooled: Please describe your plans for next year:
List school activities you have participated in:
What is your anticipated career choice?
2
Current Age:
PERSONAL NARRATIVE List three 4-H projects that have had the most impact on you and why?
What has being a Wyoming County 4-H member meant to you?
3
How do you feel you have grown through your participation in the Wyoming County 4-H program?
Highlight one 4-H event and the impact it has had on you as a person.
4
How have the skills gained in the Wyoming County 4-H program impacted your life outside of 4-H?
How do you plan to give back to 4-H and your community?
- END OF APPLICATION -
5
4-H EDUCATOR RECOMMENDATION This page is designated for one of your 4-H Educators to provide input and remarks for the selection committee regarding your participation in the Wyoming County 4-H program as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
4-H Membership in General:
1
2
3
4
5
4-H Project Work:
1
2
3
4
5
4-H Leadership Roles:
1
2
3
4
5
4-H Community Service:
1
2
3
4
5
County 4-H Activities:
1
2
3
4
5
Total number of years of 4-H participation: How do you feel the applicant has grown as a person through their participation in the Wyoming County 4-H program?
I certify that this applicant has been enrolled in the Wyoming County 4-H Program. I have reviewed the application and I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature:
Date:
ACADEMIC RECOMMENDATION This page is designated for one of your Academic Instructors to provide input and remarks for the selection committee regarding your participation in your school community as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
Scholastic Work:
1
2
3
4
5
School Leadership Roles:
1
2
3
4
5
School Community Service:
1
2
3
4
5
Involvement in School Activities:
1
2
3
4
5
Total number of years you have known the applicant: Does the applicant work to the best of their ability?
How does the applicant demonstrate leadership in the school community?
What is the applicant’s strongest attribute?
I certify that this applicant has been a student in our school community. I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature: School District:
Date:
EMPLOYER RECOMMENDATION This page is designated for one of your Employer’s (either paid or volunteer) to provide input and remarks for the selection committee regarding your participation in your work as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
Work Ethic:
1
2
3
4
5
Work Leadership Roles:
1
2
3
4
5
Commitment to Responsibilities:
1
2
3
4
5
Total number of years you have known the applicant: Does the applicant work to the best of their ability?
How does the applicant demonstrate a strong work ethic?
What is the applicant’s strongest attribute?
I certify that this applicant has been an employee or volunteer at my organization. I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature:
Date:
4-H VOLUNTEER RECOMMENDATION This page is designated for one of your 4-H Volunteer’s (not related to you) to provide input and remarks for the selection committee regarding your participation in the Wyoming County 4-H program as well as general information about the applicant. This information is particularly important for the corroboration of information and statements – it will be maintained in strict confidence. Please rate the applicant in the following categories by selecting the most appropriate response: Below Average
Satisfactory
Above Average
4-H Membership in general:
1
2
3
4
5
4-H Project work:
1
2
3
4
5
4-H Leadership roles:
1
2
3
4
5
4-H Community Service:
1
2
3
4
5
Attendance at 4-H activities:
1
2
3
4
5
Total number of years of 4-H participation: How do you feel the applicant has grown as a person through their participation in the Wyoming County 4-H program?
I certify that this applicant has been enrolled in the Wyoming County 4-H Program. I recommend the applicant be considered for a Wyoming County 4-H Leadership Scholarship. Signature:
Date:
