Attach a picture of yourself

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1 Attach a picture of yourself Name Address First/Middle/Last Street/City/State/Zip (Staple this page to front cover of application) 4-H SCHOLARSHIP APPLICATION COVER SHEET Parish: Check scholarship(s) you are applying for: Must be graduating senior in 2015 and entering college in the summer or fall Carl & Beulah Baldridge Memorial ($2,000) Jason McClaran Memorial ($500) LSU-BR College of Agriculture major Lyle Maier Tinker Bayle ($2,000) LSU-BR College of Agriculture Dr. & Mrs. Edward W. Gassie ($500) LSU-BR College of Agriculture major Bruce Flint Memorial ($1,200) Ruth Johnson Memorial ($500) Gloria B. Perkins ($1,000) LSU-BR Animal Science Major Gerry Lane Enterprises ($500) Must attend LSU-BR and have 3.0 GPA Terril D. Faul ($1,000) Louis Mouch ($400) West Baton Rouge 4-H Member A.P. & Beryl Parham Memorial ($1,000) Animal Science major at LSU or any of its branch campuses Lee Berwick Memorial ($300) Animal Science major Troy A. Menard Memorial ($1,000) Mark H. Bonner Memorial ($300) C.J. Naquin ($800) Emphasis on leadership roles & 4-H accomplishments Joseph & Malvina Lamendola Memorial ($300) Larry T. Brock Memorial ($750) H. C. Sanders Memorial ($300) Larry dela Bretonne, Jr. Memorial ($600) LSU/BR Wildlife/Fisheries Major Daniel Fontenot, Jr. ($300) Cliff Williams Memorial ($600) Joe Walters Family ($250) Participation in 4-H Shooting Sports McCrory Family ($600) Emphasis on leadership and community service Joe Barrett Memorial ($250) Participation in 4-H Shooting Sports Lod Cook ($500) LA 4-H Foundation Parish ($100) American Legion ($500) Agriculture major at a Louisiana University Parish 4-H s Kenneth anb Mary Beatty Memorial ($1,200) Must be from Webster or Bienville Parish Hilda D. and Vardaman Williams, Jr. Must be from Avoyelles, Bienville, Bossier, Caddo, Caldwell, Catahoula, Claiborne, Concordia, DeSoto, East Carroll, Franklin, Grant, Jackson, LaSalle, Lincoln, Madison, Morehouse, Natchitoches, Ouachita, Rapides, Red River, Richland, Sabine, Tensas, Union, Vernon, Webster, West Carroll or Winn Parish Sidney and Cecile Wood Must be from St. James Parish Beauregard CattleWomen ($500) Must be from Beauregard, Vernon or Allen Parish Holbern Bot Burch Memorial Must be from Washington Parish Scotty Moore Memorial Must be from Bossier Parish Charles Fuselier Must be from St. Martin Parish HAVE YOU ATTACHED THE FOLLOWING? 1. Application Form (additional pages added only where option is given). 2. Transcript of grades, including mid-term grades, signed by an appropriate official. 3. Copy of ACT scores. 4. Letter of recommendation from academic advisor on school letterhead stationery. 5. Report the past three (3) years of club work. Use one page per school year.

2 Name (First/Middle/Last) SECTION 1 Personal / Academic Data Age Date of Birth: Month January Day Year Address City Zip Parish Gender Name of Parents or Guardians Number of Years in 4-H Name and Address of High School Male Grade Class Rank Number in Class Cumulative GPA Academia Honors received: National Testing Score: ACT Date Tested (attach copy of scores) Name and address of college or school you plan to attend September 1st of this year: In what field or course of study do you plan to major or concentrate? Why have you chosen this field of study? I have personally prepared/reviewed this application and believe it to be correct: Signed (Club Member) Date Signed (Parent or Guardian) Date Signed (Parish Extension Agent) Date

3 School Year SECTION 2 4-H Leadership List any time you taught, coordinated, organized or guided others through your 4-H work. List 4-H officer position(s) held, committees served on or other positions held. Leadership and community service develop with growth younger members will have fewer examples. Responsibility/Accomplishment(s) Example: Club demonstration Taught 28 clubs members how to make a healthy snack. Example: Served as safety chairman-school club; prepared monthly safety reports and activities for eight club meetings. Level (L - Local, P - Parish, S - State, N - National) (L) (L) Only one page per school year.

4 School Year SECTION 3 Citizenship/Community Service How were you able to show your caring and citizenship qualities in 4-H this year? List 4-H activities you have participated in to help others in your community. Include hours/type of service/number of items donated, etc. Description of Activity Example: Donated 6 canned goods for Food for Families Food Drive. Level (L - Local, P - Parish, R- Regional, S - State, N - National) (L) Only one page per school year.

5 SECTION 4 School Year 4-H Awards & Recognition List the awards, honors, recognitions you have received in 4-H, including contests, workshops, trips, etc. Award/Recognition Example: Certificate of Participation Example: Certificate-Blue Ribbon For What Received Attendance- State 4-H Marsh Maneuvers Area Commodity Ambassador Talk-Egg Only one page per school year.

6 School Year SECTION 5 Non-4-H Experiences Leadership List any time you taught, helped or guided others. List officer position(s) held, committee(s) served on or other positions held. Include only non-4-h work. Responsibility/Accomplishment(s) Example: Youth Praise Team; Captain-Softball Team Non 4-H Awards & Recognition Type of Award For What Received Example: Plaque-1st Place Community Beautification Poster Contest Only one page per school year.

7 SECTION 6 Impact Focus How did your 4-H experiences help to influence your life? What has 4-H done for you and how have you utilized that to impact your community and state? Limit your story to 3 pages typed only. You may add up to 2 extra pages.

8 SECTION 7 School Year Supporting Materials 1. Transcript of grades, including mid-term grades, signed by school official. 2. Copy of ACT scores. 3. Letter of recommendation from academic advisor on school letterhead. 4. Specific scholarship requirements, if applicable. 5. Reminder any handwritten application will be deducted 5% of your total score by the judges.

9 Applicants must be a class of 2015 high school graduate: Deadline: Friday, March 6, 2015 at 4:30pm Louisiana 4-H Foundation 2015 s Program/Donor Number of s & Amounts Pursue Studies In: * Requirements Fall 2013 Candidate Must Be in College/University Carl & Beulah Baldridge 4-H Foundation $2,000 Any field of study at Lyle Maier Tinker Bayle $2,000 Any field of study at LSU-BR College of Agriculture Bruce Flint 4-H Foundation Memorial Gloria B. Perkins 4-H Foundation Memorial $1,200 Any field of study at $1,000 Animal Science at LSU/BR Entering Freshman at LSU/BR majoring in Animal Science Terril D. Faul $1,000 Any field of study at any accredited college or university in Louisiana. Must be full-time student. A.P. & Beryl Parham 4-H Foundation Memorial $1,000 Animal Science at LSU or any LSU branch Entering freshman majoring in Animal Science Troy A. Menard Memorial $1,000 Any field of study at any accredited college or university in Louisiana C.J. Naquin 4-H Foundation Leadership $800 Any field of study at Larry T. Brock Memorial $750 Any field of study at. Must be full-time student.. Emphasis on 4-H leadership roles & accomplishments. Larry De La Bretonne, Jr. 4-H Foundation Memorial $600 Wildlife & Fisheries at LSU/BR could be one of 4 areas: a. Aquaculture b. Fisheries c. Fish & Wildlife Conservation d. Wildlife Entering freshman at LSU/BR. *Note: Should there not be a qualified incoming freshman applicant, an upper-classman in the Wildlife & Fisheries Program at LSU who is a former 4-H er majoring in Aquaculture, Fisheries, Fish & Wildlife Conservation or Wildlife may apply.

10 Cliff Williams 4-H Foundation Memorial McCrory Family 4-H Foundation Lodwrick Lod Cook 4-H Foundation Achievement American Legion American Legion Ag. Committee $600 Any field of study at $600 Any field of study at LSU-BR $500 Any field of study at $500 Agriculture at any college in Louisiana. Emphasis on 4-H leadership & community service. Jason McClaran 4-H Foundation Memorial Dr. & Mrs. Edward W. Gassie 4-H Foundation $500 College of Agriculture at LSU-BR $500 LSU College of Agriculture including Human Ecology Ruth Johnson 4-H Foundation $500 Any field of study at Gerry Lane Enterprises 4-H Foundation $500 Any field of study at LSU/BR Louis Mouch Memorial $400 Any field of study at any accredited college or university in LA Lee Berwick 4-H Foundation Memorial Mark H. Bonner, Jr. 4-H Foundation Achievement Joseph & Malvina Lamendola 4-H Foundation H. C. Sanders Memorial Career Daniel Fontenot, Jr. 4-H Foundation $300 Animal Science at any accredited college or school $300 Any field of study at $300 Any field of study at $300 Any field of study at $300 Any field of study at Joe Walters Family $250 Any field of study at any accredited 2 or 4 year school Joe Barrett Memorial $250 Any field of study at LA 4-H Foundation Parish s $100 (1 per parish) Any field of study at at the LSU College of Agriculture at the LSU College of Agriculture. Must be a West Baton Rouge 4-H Member *Applicants must show in the 4-H project section significant work in the Beef and/or Horse projects. Show evidence of 4-H influence on selection of career. Mimimum 2 years participation in 4-H Shooting Sports Participation in 4-H Shooting Sports. Award based on overall 4-H project work, citizenship/community service, leadership, and academic need.

11 Program/Donor Kenneth and Mary Beatty Memorial Beauregard CattleWomen Association Hilda D. Williams and Vardaman Williams, Jr. Other 4-H s: Number of Pursue Studies In: s & Amounts $1,200 Any field of study enrolling as a full-time undergraduate student in any two or four year college within the State of Louisiana. $500 Agriculture related degree at any 4-year institution in Louisiana. $500 Any field of study at any two or four year college in the State of Louisiana. * Requirements 2.5 grade point average or higher who have participated in the Webster or Bienville Parish 4-H Program. Financial need may be a consideration.. Must be full-time student. 4- H er must be from Beauregard, Vernon, or Allen Parish. Selection will be based on the academic performance and 4-H achievements of the eligible students. The recipient must be a 4-H er from one of the following parishes: Avoyelles, Bienville, Bossier, Caddo, Caldwell, Catahoula, Claiborne, Concordia, DeSoto, East Carroll, Franklin, Grant, Jackson, LaSalle, Lincoln, Madison, Morehouse, Natchitoches, Ouachita, Rapides, Red River, Richland, Sabine, Tensas, Union, Vernon, Webster, West Carroll or Winn Parish. Sidney and Cecil Wood Any field of study. The recipient must be a 4-H er from St. James Parish. Holbern Bot Burch Memorial Any field of study. The recipient must be a 4-H er from Washington Parish. Charles Fuselier Any field of study. The recipient must be a 4-H er from St. Martin Parish. Scotty Moore Memorial Any field of study. The recipient must be a 4-H er from Bossier Parish. NOTE: All scholarships will be awarded upon completion of the first semester by submitting a college transcript and personal thank you card addressed to the scholarship sponsor/donor to the Louisiana 4-H Foundation Office. s will be withdrawn from the recipient for any of the following reasons: being placed on disciplinary probation; or resigning and/or "dropping out" of the University. *SCHOLARSHIP REQUIREMENTS: In addition to the requirements listed above, scholarship applicants must submit the following: 1. 4-H scholarship form must be typed. 2. Transcript of grades, including mid-term grades of senior year. 3. Copy of ACT scores. 4. One letter of recommendation from an academic advisor. 5. Any handwritten applications will be automatically deducted 5% of the total score from the judges. judging will take place in Baton Rouge in mid-march. Winners will be notified via their 4-H Agent by April 11, s will be judged by a committee of 4-H Agents/Volunteers representing the five Louisiana 4-H regions. Applications will be scored on leadership (30%), citizenship/community service (30%), non 4-H experiences (15%), impact focus (20%) and presentation (5%). Each application will be scored independently by each judge on the committee.