2016 SCHOLARSHIP APPLICATION
2016 SCHOLARSHIP APPLICATION Deadline: December 1, 2015
Social Security Number
First Name
Last Name
Address
Cell Phone Number
City
Home Phone Number
GPA
Student’s Email Address (Majority of communication will be done via email)
I will be a full-time college student in the fall of 2016.
Jacket Size (S, M, L, XL, XXL)
Yes
No
I plan to attend one of the following schools: Oklahoma State University Southwestern Oklahoma State University Redlands Community College Cameron State University Connors State College Northwestern Oklahoma State University Northeastern Oklahoma College Murray State College Other; please list ________________________________
My major field of study will be:
Zip
Name of Agricultural Education Instructor / County Extension Educator
Number of years competed at the OYE
I plan to pursue a degree in the medical field.
State
Parent’s Names
Name of FFA Chapter or 4-H Club
Specie(s) you will be showing at the 2016 OYE
Birthdate
Yes
No
Please use information from most recent tax forms filed with the IRS. 1. Estimated educational expenses $ 2.
I am a dependent.
/ year
I am independent.
(If dependent, go to question 3. If independent, go to question 5.) 3. Number of family members including myself 4. Number of family members attending college Applicant/Student
Parent/Guardian
5. Personal income from non-farm employment as stated on most-recent tax forms
$
$
6. Net farm income or (loss)
$
$
7. Other sources of income to assist in college expenses
$
$
8. Family contribution to estimated college expenses
$
$
9. Please explain any unusual circumstances (emergency or medical expenses, debts on farm or business, etc.)
10. Please list any scholarships or monetary academic awards received as of application deadline date.
Please indicate if you are a certified member of a federally recognized tribe, and if so, which tribe. Yes Tribe
No Please list the name of your family banking institution:
Please list most significant 4-H and FFA leadership positions using only the bullets provided. • • • • • • • • Please list most significant 4-H and FFA awards using only the bullets provided. • • • • • • • • Please list most significant show ring accomplishments using only the bullets provided. • • • • • • • • Please list most significant community leadership activities using only the bullets provided. • • • • • • •
Please Note: Essay #1 and Essay #2 are required for all scholarship applications. All essays must be double-spaced and typed in Times New Roman, 12-point font.
Essay #1 Attach a short essay (maximum 500 words) on how the Junior Livestock Program has contributed to your higher educational and career pursuits. Essay #2
Attach a short essay (maximum 500 words) on your ten-year goals in life and how those pursuits will help make the state of Oklahoma a better place. Transcript Attach a current copy of your official high school transcript including a current class ranking. Resume Attach a one or two page resume that includes the following sections: • Name/Address/Phone Number/E-mail Address/FFA Chapter or County 4-H Club • Career Objective • Education • 4-H / FFA Leadership Activities/Awards • School Leadership Activities/Awards • Community Leadership Activities/Awards • Professional Associations • Other Accomplishments • References Photo Please include a WALLET sized photo with each of your application copies. Application (IMPORTANT!) Applications need to be STAPLED together at the top left hand corner. Do not submit applications in any type of binder or folder. Please provide FIVE COMPLETE COPIES of your application – these will be distributed to each of the judges on the scholarship committee.
Local Newspaper Name: Newspaper’s Email Address:
____________ Newspaper’s Fax Number:
__________________
I hereby certify that the information submitted on this application by the applicant is true and correct to the best of my knowledge. I have reviewed this application for any misinformation and have found none. If misinformation is found, I may be held accountable for the student’s disqualification. (AEI=Agricultural Education Instructor, CEE=County Extension Educator)
AEI or CEE First Name
AEI or CEE Last Name
AEI or CEE Signature (Required)
Applicant Signature (Required)
Date
Parent(s) / Guardian(s) Signature (Required)
Date
Social Security Number
First Name
Last Name
Address
Cell Phone Number
City
Home Phone Number
GPA
Student’s Email Address (Majority of communication will be done via email)
I will be a full-time college student in the fall of 2016.
Jacket Size (S, M, L, XL, XXL)
Yes
No
I plan to attend one of the following schools: Oklahoma State University Southwestern Oklahoma State University Redlands Community College Cameron State University Connors State College Northwestern Oklahoma State University Northeastern Oklahoma College Murray State College Other; please list ________________________________
My major field of study will be:
Zip
Name of Agricultural Education Instructor / County Extension Educator
Number of years competed at the OYE
I plan to pursue a degree in the medical field.
State
Parent’s Names
Name of FFA Chapter or 4-H Club
Specie(s) you will be showing at the 2016 OYE
Birthdate
Yes
No
Please use information from most recent tax forms filed with the IRS. 1. Estimated educational expenses $ 2.
I am a dependent.
/ year
I am independent.
(If dependent, go to question 3. If independent, go to question 5.) 3. Number of family members including myself 4. Number of family members attending college Applicant/Student
Parent/Guardian
5. Personal income from non-farm employment as stated on most-recent tax forms
$
$
6. Net farm income or (loss)
$
$
7. Other sources of income to assist in college expenses
$
$
8. Family contribution to estimated college expenses
$
$
9. Please explain any unusual circumstances (emergency or medical expenses, debts on farm or business, etc.)
10. Please list any scholarships or monetary academic awards received as of application deadline date.
Please indicate if you are a certified member of a federally recognized tribe, and if so, which tribe. Yes Tribe
No Please list the name of your family banking institution:
Please list most significant 4-H and FFA leadership positions using only the bullets provided. • • • • • • • • Please list most significant 4-H and FFA awards using only the bullets provided. • • • • • • • • Please list most significant show ring accomplishments using only the bullets provided. • • • • • • • • Please list most significant community leadership activities using only the bullets provided. • • • • • • •
Please Note: Essay #1 and Essay #2 are required for all scholarship applications. All essays must be double-spaced and typed in Times New Roman, 12-point font.
Essay #1 Attach a short essay (maximum 500 words) on how the Junior Livestock Program has contributed to your higher educational and career pursuits. Essay #2
Attach a short essay (maximum 500 words) on your ten-year goals in life and how those pursuits will help make the state of Oklahoma a better place. Transcript Attach a current copy of your official high school transcript including a current class ranking. Resume Attach a one or two page resume that includes the following sections: • Name/Address/Phone Number/E-mail Address/FFA Chapter or County 4-H Club • Career Objective • Education • 4-H / FFA Leadership Activities/Awards • School Leadership Activities/Awards • Community Leadership Activities/Awards • Professional Associations • Other Accomplishments • References Photo Please include a WALLET sized photo with each of your application copies. Application (IMPORTANT!) Applications need to be STAPLED together at the top left hand corner. Do not submit applications in any type of binder or folder. Please provide FIVE COMPLETE COPIES of your application – these will be distributed to each of the judges on the scholarship committee.
Local Newspaper Name: Newspaper’s Email Address:
____________ Newspaper’s Fax Number:
__________________
I hereby certify that the information submitted on this application by the applicant is true and correct to the best of my knowledge. I have reviewed this application for any misinformation and have found none. If misinformation is found, I may be held accountable for the student’s disqualification. (AEI=Agricultural Education Instructor, CEE=County Extension Educator)
AEI or CEE First Name
AEI or CEE Last Name
AEI or CEE Signature (Required)
Applicant Signature (Required)
Date
Parent(s) / Guardian(s) Signature (Required)
Date
