Renewable Scholarship Application to a Technical/Certification Program 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/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 Technical School or Certification Program Next Year Anticipated Graduation/End of Program Date Address of School you are planning to attend Telephone Number Describe your School Activities over the past 4 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 all Projects completed and how many years in each project 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 Technical or Certification Program What is your Career Objective OTHER INFORMATION Give us examples of activities, events, projects, etc., that demonstrate what you have done in the past four years that relate to your upcoming Technical/Certification Program Give us a Summary Statement of why you should receive this Scholarship Electronic Signature Δ
