2020 Arizona 4-H Youth Foundation Scholarship Application Cover Sheet and Checklist

Please fill out the application and send it to your County Extension office to be signed. Each county has a unique deadline date, please inquire with your County Extension office about their deadline date. The County Extension Office will then forward all applications from their county to the Arizona 4-H Youth Foundation Office by the Foundation Deadline February 17th, 2020 – No Exceptions.

County 4-H Offices: Please review, sign, and fill Excel sheet (provided) as a cover sheet to all applications. Keep originals and provide scanned copies of references, transcripts, and the Excel sheet to the address below or scan and put in Box provided to each County Extension office…

Arizona 4-H Youth Foundation 325 Forbes Building- The University of Arizona PO Box 210036 Tucson AZ 85721-0036

1. All Applicants must fill out Section I. ONLY those believing they qualify for a financial

need-based scholarship need to complete Section II, Part K.

2. All applications must be typed. Only reference sheets may be handwritten.

3. References must use the reference form provided. No substitutions or additional pages will be

accepted.

4. Please only use the space provided in each section. No additional pages may be added to this

application.

5. Ensure that all signature lines throughout this document are signed.

6. Complete all forms and submit all information included in the checklist below.

Incomplete applications will not be accepted.

Name: ______________________

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Application Checklist Section I ☐ Part A - Background Information☐ Part B - Educational Information☐ Part C - Projects Record☐ Part D - 4-H Leadership☐ Part E - 4-H Community Service/Volunteer Work☐ Part F - 4-H Communication Skills☐ Part G - Other Activities☐ Part H - Employment Record☐ Part I - 4-H Youth Development Statement☐ Part J – References (You should have two references filled out by differentpeople. Can be scanned)

☐ One from a 4-H leader or Extension agent where you are a member☐ One from a non-4-H source: schoolteacher, counselor, administrator,past employer, minister, physician, etc. MAY NOT BE A PARENT orGUARDIAN

Section II •

☐ Part K- Financial Information• Need for only those who believe they qualify for a financial need-based

scholarship.

Application must also include: ☐ Complete Photo Release Form (Located at the end of the application)☐ Transcripts should be scanned and included with the application.

Original scanned of the entire application (including transcripts and references)

Name: ______________________

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2020 Arizona 4-H Youth Foundation Scholarship Application

The Arizona 4-H Youth Foundation awards educational scholarships to 4-H members who have college or university aptitude. Some awards are based on financial need; others are based solely on merit.

General Information • All information is held in strict confidence by Extension personnel, Foundation staff, and

Volunteers serving on the Scholarship Selection Committee.• Scholarship funds are deposited within the institution to be attended by the recipient. The

institution will be instructed that half of the scholarship is to be paid for the first semester.The other half is to be paid for the second semester if a “C” average grade, based on 12 ormore credit hours has been maintained.

• Upon notification of award, recipients of educational scholarships must write a thank youletter to the sponsoring person/organization. A copy of this thank you letter and a validstudent ID number must be received in the Arizona 4-H Youth Foundation office beforefunds will be deposited with the educational institution.

• Submit a photo of yourself at least 568 x 462 pixels which will be upload to the Arizona4-H Youth Foundation website.

• All scholarship recipients will be featured on the Arizona 4-H Youth Foundation websiteand possibly the newsletter.

• Scholarship award must be used during the 2020-2021 school year and cannot be rolledover to the 2021-2022 school year.

Eligibility • A new application must be submitted each year.• You must have been a 4-H member for a minimum of 2 full years, which may include the

current year. Involvement during your senior year is preferred but not required.• Former 4-H members from any state and previous recipients who are continuing their

education at an accredited University or Community College in the Fall of the year inwhich the scholarship is to be awarded, and who meet the 2 year 4-H memberrequirement are encouraged to apply.

• You must carry a minimum number of 12 credits a semester to be a full-time student.

Name: ______________________

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I prepared this application myself and certify that the information is accurate.

Full name and Initials of applicant: ___________________________ Date: ______________

Further, I agree to allow the Arizona 4-H Youth Foundation to publish quotes and excerpts from the essay portion of this application to further the development of the 4-H Youth Development and the University of Arizona Cooperative Extension in Arizona. Not signing this section to release quotes will not affect this application in any way.

Full name and Initials of applicant: ___________________________ Date:_______________

I/We reviewed this application and believe it to be correct.

Full name and Initials of Parent/Guardian: _________________________ Date:____________(Parent signature is not necessary if applicant is 18 years of age or older; parent signature is required if applicant is a minor.) Full name and Initials of County Agent: ___________________________Date:___________

Background Information- Part A Please check all that apply:

☐ This is my first time applying.☐ I have applied before.☐ I have received the Arizona 4-H Youth Foundation Scholarship before.

Applicant Information

Name:

Zip____________

( Last, First, Middle)

Date of Birth:_______________________ Sex: ☐Male ☐Female

Home Address:____________________________________________________________

Number of Years: _______

City ________________________ State ________________

Email Address: ___________________________________________ C ounty where you are/were a 4-H Member:

Phone Numbers: Home:________________________ Cell:__________________________

Name: ______________________

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If you believe you are eligible for any of the following special scholarships, please check and provide the additional information required.

☐ Cochise County Jr Livestock Merit Scholarship:Exhibited Livestock at the Cochise County Fair for a minimum of 3 years. Reference provided by a Cochise County Livestock Council Member (Marked as additional. Will not be used in consideration for other scholarships.)

☐ Colorado River 4-H Small Stock Show Merit ScholarshipExhibited at least one time at the Colorado River Small Stock Show. Attending a 2 or 4 Year College

☐ Pima County Horse Project 4-H Merit Scholarship I have been active in Pima County Horse Project for ____ years.

☐ Pima County Jr Livestock Sales Merit Scholarship Pima County Projects Completed: (Check all that Apply)

☐ Beef ☐Sheep ☐Swine ☐Rabbits ☐Cavy

☐Poultry ☐ Pigeon ☐Pygmy Goats ☐Market Goat

☐ Valley TeleCom Group Customer of Valley TeleCom Group within Cochise, Graham, or Greenlee Counties.

Educational Information- Part B In the Fall of 2020, you will be a:

☐ College Freshman

☐ College Sophomore

☐ College Junior

☐ College Senior

☐ Graduate StudentWhat is your anticipated college graduation date?

Name and address of the financial office of the college you plan to attend.

Name: ______________________

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Course of Study

What is your anticipated (or declared) major? ________________________________________

What is your anticipated (or declared) minor? ________________________________________

Academic Information College Information (If Applicable)

Cumulative GPA of ______________ on a 4.0 scale.

College student ID number

High School Information

High school rank is/was _______in a class of ______ students.

High school GPA of ______ on a 4.0 scale.

SAT Score: ________ or ACT Score: ________

Academic Honors Received:

Name: ______________________

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Projects Record- Part C Summary of 4-H Projects

List the 10 most important 4-H projects that you have exhibited/participated in and include the years in which you participated in each project.

Project: Year(s)

Example: Market Beef 2010-2014

Name: ____________________

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4-H Leadership - Part D

Year(s) Position Held Club/ Project What was your role? What did you do/learn?

Example: 2012-2014

Club President AZ 4-H Youth Foundation 4-H Club

Served as president leading club meetings and assisting with club activities. I learned public speaking, organizational, and leadership skills.

List the 5 most important 4-H leadership experiences that you have undertaken. For example: elected or appointed offices held, committee chaired or served on, junior or teen leader, helping younger members, Youth Adult Council, or any role(s) that involved development of leadership.

Name: ______________________

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4-H Community Service/VolunteerWork - Part E

List the 5 most important community service projects in which you have participated with a group or as an individual which meant the most to you. For example: Sharing your time by visiting a retirement home or hospital, helping with a community event, serving others, donating time or items to groups in need, beautification projects, etc. Please indicate in the last column whether it was 4-H related.

Year(s) Group or Club Conduction Project

Service Description What did you do?

Hours Spent 4-H or Other

Example: 2010-2014

AZ 4-H Youth Foundation 4-H Club

Collected Christmas gifts for low-income families with my 4-H club.

10 4-H

Name: ______________________

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4-H Communication Skills - Part FList the 5 most important 4-H demonstrations, illustrated talks, prepared talks, website developments, news articles, TV or radio presentations and/or speeches you have done. Also record the level at which the communication activity occurred.

Year(s) Title of Communication Activity

Description Number of Times

Level L=Local S=State N=National

Example: 2013

MC 4-H Awards Ceremony

Spoke at a local 4-H award ceremony about 4-H and exceptional volunteers who had a significant contribution to 4-H throughout the year.

1 L

Name: ____________________

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Other Activities - Part G

List the 5 most important activities in any other development or youth organizations, clubs, and community service activities outside of 4-H. Indicate the years of your involvement. Year(s) Other Organization/Club Description of Activities done with the

organization Example: 2012-2014

High School Softball Played outfield for my high school softball team attending daily practices and competing against other Arizona teams.

Employment Record-Part H Employment (List the two most important employment activities in which you have been

paid during the past two years)

Full name and Initials of Applicant_________________________________ Date:_________________

Employer Job Description Length of Service

Hours Per Week

Name: ______________________

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4-H Youth Development Statement - Part IThis is a personal statement. Please write a well-developed essay describing your growth in 4-H and how it has influenced your life. Consider your personal development through your 4-H project work, leadership, and community service. Please share such things as how 4-H has impacted your self-image, your school success, your career choices, your goals, your abilities, your character, etc.

Include proper use of spelling and grammar. (Note: This page must be typed, using 10pt font, and not exceed the space provided on this page. Attached essays are not accepted).

Name: ______________________

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NON- 4-H Reference ONLY - Part J 4-H Youth Development Educational Scholarship Award

This page may be handwritten. References must use this form with no additional pages attached.

Applicant’s Name: _____________________________

Your Name: __________________________________

How long have you known the applicant? _____________________

Relationship to the applicant: _________________

Your Address:______________________________________________________

City ________________________ State ________________ Zip____________

Please rate the applicant named above on each of the characteristics listed below and comment on your rating.

Why do you recommend this applicant for an educational scholarship? Please be specific.

Full name and Initials: _____________________________________ Date: _____________________

Characteristics Score (5=High; 1=Low)

A. Capacity to AchieveComments:

B. ReliabilityComments: 5 4 3 2 1

5 4 3 2 1

Name: ____________________

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Why do you recommend this applicant for an educational scholarship? Please be specific

NON- 4-H Reference ONLY - Part J 4-H Youth Development Educational Scholarship Award

This Page May Be Handwritten. References Must Use This Form, With No Additional Pages attached.

Applicant’s Name: ___________________________________________

Your Name: _________________________________________________

How long have you known the applicant? _________________________

Relationship to the applicant: ___________________________________ Please rate the applicant named above on each of the characteristics listed below and comment on your rating.

5 4 3 2 1

Full name and Initials:_________________________________ Date:______________________

Characteristics Score (5=High; 1=Low)

A. Capacity to Achieve 5 4 3 2 1 Comments:

B. ReliabilityComments:

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Section II Financial Need –Part K

Note: This form only needs to be filled out if you believe you qualify for a financial need-based scholarship. This form must be typed.

Parent/Guardian/Family Information

☐ I certify that, to the best of my knowledge, the above information is accurate andcomplete.

Parent/Guardian Full Name and Initials: _____________________________ Date:____________

Number of Family Members Include parents’ other children or family members for whom they provide more than half of their support. Number of family members in college at least half-time during the next calendar year. (Including the applicant) For the year immediately past, what was the family’s Adjusted Gross Income? (use adjusted gross income line from Federal IRS forms. If the information for the year immediately past is not available, give the prior year.)

$

Are there any special circumstances that have influenced your need for financial assistance? Describe why you feel you have a need for financial assistance through the Arizona 4-H Youth Foundation Scholarships. Note any circumstances not previously given that indicate your financial need or compelling reasons for earning a scholarship. What have you done to date to help finance your college education? What do you intend to do during college to finance your education? (Note: This section must be typed, and not exceed the space provided on this page. Attached essays are not accepted.)

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Photo Release Form

I grant permission to The Arizona 4-H Youth Foundation, a non-profit educational organization, separate from the University of Arizona but sanctioned by The Arizona Board of Regents, University of Arizona administration, and the College of Agriculture & Life Sciences and Cooperative Extension to use photographs taken of me for use in publications such as recruiting brochures, newsletters, and magazines, on display boards, and to use such photographs in electronic versions of the same publications or on websites or other electronic form or media, and to offer them for use or distribution in University publications, electronic or otherwise, without notifying me.

I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph. For purposes of clarity, I expressly waive any and all moral rights I may have in connection with my appearance. I hereby agree to release, defend, and hold harmless The Arizona 4-H Youth Foundation, the Arizona Board of Regents, on behalf of The University of Arizona and its agents or employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.

I am 18 years of age or older and I am competent to contract in my own name. I have read this release before signing below, and I fully understand the contents, meaning, and impact of this release. I understand that I am free to address any specific questions regarding this release by submitting those questions in writing prior to signing, and I agree that my failure to do so will be interpreted as a free and knowledgeable acceptance of the terms of this release.

Name (please print): ____________________________________ Date: ________________

Initials: ____________________________________________

Full name and Initials of Parent/Guardian: ______________________ Date:____________ (if under 18 years of age)

2020 Arizona 4-H Youth Foundation Scholarship ApplicationBackground Information- Part ACourse of StudyAcademic Information

Projects Record- Part C4-H Leadership - Part D4-H Community Service/Volunteer Work - Part E4-H Communication Skills - Part FOther Activities - Part GEmployment Record-Part H4-H Youth Development Statement - Part INON- 4-H Reference ONLY - Part JNON- 4-H Reference ONLY - Part J4-H Youth Development Educational Scholarship Award

Name: Part A Background Information: OffPart B Educational Information: OffPart C Projects Record: OffPart D 4H Leadership: OffPart E 4H Community ServiceVolunteer Work: OffPart F 4H Communication Skills: OffPart G Other Activities: OffPart H Employment Record: OffPart I 4H Youth Development Statement: OffPart J References You should have two references filled out by: OffOne from a 4H leader or Extension agent where you are a member: OffOne from a non4H source schoolteacher counselor administrator: OffPart KFinancial Information: OffComplete Photo Release Form Located at the end of the application: OffTranscripts should be scanned and included with the application: OffName_2: Name_3: Date_2: This is my first time applying: OffI have applied before: OffI have received the Arizona 4H Youth Foundation Scholarship before: OffLast First Middle: Sex: OffHome Address: City: State: Zip: Email Address: Number of Years: Phone Numbers Home: Cell: Name_4: Cochise County Jr Livestock Merit Scholarship: OffColorado River 4H Small Stock Show Merit Scholarship: OffPima County Horse Project 4H Merit Scholarship: OffPima County Jr Livestock Sales Merit Scholarship: OffValley TeleCom Group: OffI have been active in Pima County Horse Project for: Beef: OffSheep: OffSwine: OffRabbits: OffCavy: OffPoultry: OffPigeon: OffPygmy Goats: OffMarket Goat: OffCollege Freshman: OffCollege Sophomore: OffCollege Junior: OffCollege Senior: OffWhat is your anticipated college graduation date: Name and address of the financial office of the college you plan to attend: Name_5: What is your anticipated or declared major: What is your anticipated or declared minor: Cumulative GPA of: College student ID number: High school rank iswas: in a class of: High school GPA of: or ACT Score: Name_6: 20102014Row1: Example Market BeefRow2: 20102014Row2: Example Market BeefRow3: 20102014Row3: Example Market BeefRow4: 20102014Row4: Example Market BeefRow5: 20102014Row5: Example Market BeefRow6: 20102014Row6: Example Market BeefRow7: 20102014Row7: Example Market BeefRow8: 20102014Row8: Example Market BeefRow9: 20102014Row9: Example Market BeefRow10: 20102014Row10: Name_7: AZ 4H Youth Foundation 4H ClubRow1: Served as president leading club meetings and assisting with club activities I learned public speaking organizational and leadership skillsRow1: undefined_2: AZ 4H Youth Foundation 4H ClubRow2: Served as president leading club meetings and assisting with club activities I learned public speaking organizational and leadership skillsRow2: undefined_3: AZ 4H Youth Foundation 4H ClubRow3: Served as president leading club meetings and assisting with club activities I learned public speaking organizational and leadership skillsRow3: undefined_4: AZ 4H Youth Foundation 4H ClubRow4: Served as president leading club meetings and assisting with club activities I learned public speaking organizational and leadership skillsRow4: Name_8: Example 2010 2014Row1: AZ 4H Youth Foundation 4H ClubRow1_2: Collected Christmas gifts for low income families with my 4H clubRow1: undefined_5: Example 2010 2014Row2: AZ 4H Youth Foundation 4H ClubRow2_2: Collected Christmas gifts for low income families with my 4H clubRow2: undefined_6: Example 2010 2014Row3: AZ 4H Youth Foundation 4H ClubRow3_2: Collected Christmas gifts for low income families with my 4H clubRow3: undefined_7: Example 2010 2014Row4: AZ 4H Youth Foundation 4H ClubRow4_2: Collected Christmas gifts for low income families with my 4H clubRow4: undefined_8: Example 2010 2014Row5: AZ 4H Youth Foundation 4H ClubRow5: Collected Christmas gifts for low income families with my 4H clubRow5: Name_9: Example 2013Row1: MC 4H Awards CeremonyRow1: Spoke at a local 4H award ceremony about 4H and exceptional volunteers who had a significant contribution to 4H throughout the yearRow1: 1Row1: LRow1: Example 2013Row2: MC 4H Awards CeremonyRow2: Spoke at a local 4H award ceremony about 4H and exceptional volunteers who had a significant contribution to 4H throughout the yearRow2: 1Row2: LRow2: Example 2013Row3: MC 4H Awards CeremonyRow3: Spoke at a local 4H award ceremony about 4H and exceptional volunteers who had a significant contribution to 4H throughout the yearRow3: 1Row3: LRow3: Example 2013Row4: MC 4H Awards CeremonyRow4: Spoke at a local 4H award ceremony about 4H and exceptional volunteers who had a significant contribution to 4H throughout the yearRow4: 1Row4: LRow4: Example 2013Row5: MC 4H Awards CeremonyRow5: Spoke at a local 4H award ceremony about 4H and exceptional volunteers who had a significant contribution to 4H throughout the yearRow5: 1Row5: LRow5: Name_10: Example 20122014Row1: High School SoftballRow1: Played outfield for my high school softball team attending daily practices and competing against other Arizona teamsRow1: Example 20122014Row2: High School SoftballRow2: Played outfield for my high school softball team attending daily practices and competing against other Arizona teamsRow2: Example 20122014Row3: High School SoftballRow3: Played outfield for my high school softball team attending daily practices and competing against other Arizona teamsRow3: Example 20122014Row4: High School SoftballRow4: Played outfield for my high school softball team attending daily practices and competing against other Arizona teamsRow4: Example 20122014Row5: High School SoftballRow5: Played outfield for my high school softball team attending daily practices and competing against other Arizona teamsRow5: EmployerRow1: Job DescriptionRow1: Length of ServiceRow1: Hours Per WeekRow1: EmployerRow2: Job DescriptionRow2: Length of ServiceRow2: Hours Per WeekRow2: Name_11: Name_12: Applicants Name: Your Name: How long have you known the applicant: Relationship to the applicant: Your Address: City_2: State_2: Zip_2: 5: Comments: Name_13: Applicants Name_2: Your Name_2: How long have you known the applicant_2: Relationship to the applicant_2: 5_2: 5_3: Date_7: Number of Family Members Include parents other children or family members for whom they provide more than half of their support: Number of family members in college at least halftime during the next calendar year Including the applicant: fill_6: Are there any special circumstances that have influenced your need for financial assistance Describe why you feel you have a need for financial assistance through the Arizona 4H Youth Foundation Scholarships Note any circumstances not previously given that indicate your financial need or compelling reasons for earning a scholarship What have you done to date to help finance your college education What do you intend to do during college to finance your education Note This section must be typed using 10pt font and not exceed the space provided on this page Attached essays are not accepted This page has been restricted to approximately 150 wordsRow1: complete: OffDate_9: Date_10: Date of Birth: County: Graduate Student: OffGroup1: Offpaper: Offscissors: OffDate: Full name and Initials of applicant: Full name and Initials of parent/guardian: Full name and initials of county agent: Example Market BeefRow1: Date_5: Name and Initials of Applicant: Date_6: Full name and initials: Date_8: Parent/Guardian's full name and initials: Name please print: Date_4: Why do you recommend this applicant for an educational scholarship Please be specific: SAT Score: Academic Awards: undefined_9: Development Statement: undefined_s: 52: 54: 547: 85: undefined_56: 8564: 6854: huj: 8645: