Renewable Scholarship Application to a 2-Year College All applicants must complete this form. Information from previous forms will not be used. Applicant's Name Current Address Telephone Number Email Address Date of Birth Male or Female malefemale Name of Parent(s) or Guardian with whom you live Permanent Address if different from the one listed above Telephone Number SCHOOL INFORMATION High School Cumulative GPA Previous Schools Attended Current School Attending School Attending Next Year Major Concentrations Second Major, if any Year in School (Freshman, Sophomore, etc.) Anticipated College Graduation Date (Semester and Year) Address of School you are planning to attend Telephone Number Describe your School Activities over the past four years COMMUNITY INFORMATION List Community Organizations and Volunteer Activities outside 4-H and the amount of time spent with them 4-H INFORMATION Are you currently a 4-H Member yesno List Awards/Accomplishments pertaining to your 4-H Career List all of your activities at the club level, county level, and-or district, state and national level List Offices held List Trips, Conferences, Committees you attended or were part of What 4-H Experiences have prepared you for a 2 Year College or University Degreed Program What is your Career Objective Give us a Summary Statement of why you should receive this Scholarship Electronic Signature Δ
