Indian Electric Cooperative 4-H Scholarship Application Rev. 11/2017

Indian Electric Cooperative 4-H Scholarship Checklist (For 4-H members in the Indian Electric Cooperative service area*)

o *Indian Electric Cooperative service areas include the following school districts: Cleveland, Frontier, Hominy, Jennings, Keystone, Mannford, Oilton, Olive, Pawhuska, Pawnee, Pretty Water, Prue, Sand Springs, Shidler, Woodland, Wynona and Yale.

o 4-H member in the Indian Electric Cooperative service area who is a senior in high school and in good standing with the 4-H program. Seniors who attend public or private school or those who are homeschooled are eligible for this scholarship.

o This scholarship cannot be received in the same year as being named a state project, scholarship or Hall of Fame winner.

o Scholarship recipients must claim the scholarship within 6 years of the date of high school graduation.

Materials submitted securely attached in a folder with fasteners and tabbed:o Indian Electric Cooperative 4-H Scholarship Applicationo 4-H Story (6 page maximum) (copy)o Transcript of current academic work

County:                      School District:       Name (First, middle, last):                         

Name of Parents/Guardians:                         

Complete Home Address:                         

Phone Number:      

Age September 1, current year:       Date of Birth:           

Current Grade In School:      GPA:     

List Project and Year WonState Project Level I:      Advanced Project Level II:     

List Year WonState 4-H Scholarship:     State Hall of Fame:     

I have prepared/reviewed this application and believe it to be correct

Applicant:____________________________________________ Date:                    

County Extension Educator:______________________________ Date:                    

SCORING ( For Judges Use Only) PointsScore

Score Score Avg.

Required Materials Are Complete With Signatures 5

Question and Answer Section 20

4-H Project Work (summary of all work done) 15

4-H Leadership (projects led, organized, assisted, etc through 4-H)

25

4-H Citizenship (community service projects/activities a member participates in or provides leadership for through 4-H)

25

Non 4-H Experiences 5

Academic Achievement (Transcript) 5

Totals 100

Question and Answer Section (limited to one page for both questions)

Name two specific life skills you have learned through your project work and explain why they are the most useful to you.

What are your plans after graduation?

4-H Project WorkDescribe your major accomplishments in all 4-H project work. (limit summary to this page only)

4-H Leadership Describe your major leadership experiences in all 4-H project work. (limit summary to this page only)

4-H CitizenshipDescribe your major citizenship experiences in all 4-H project work. (limit summary to this page only)

List your most important non-4-H experiences for school, church/faith or community organizations. (limit summary to this page)

Non-4-H Experiences