WOOD COUNTY MARKET LIVESTOCK SHOW SCHOLARSHIP

APPLICATION FORM

Applicant _______________________________________________________________

Home Address ___________________________________________________________

___________________________________________________________

County _________________________________________________________________

Home Telephone Number __________________________________________________

**Social Security Number __________________________________________________

Birth date _______________________________________

Place of Birth ____________________________________

Where do you live:

Farm/Ranch _______________ Small Town _______________ City _____________

Name of High School ______________________________________________________

Address of High School ____________________________________________________

_____________________________________________________

School Phone Number _____________________________________________________

Anticipated Graduation Date ________________________________________________

** By Right to Privacy, you are not required to list your Social Security number, however, that number is used as part of your student identification numbers and will be most helpful in the record keeping system. Thank you.

Family Information

Name of Parents or Guardian ________________________________________________

Address ________________________________________________________________

Phone Number ___________________________________________________________

Father: Age _____ College Attended _______________________ Graduated ______

Mother: Age _______ College Attended ______________________ Graduated _____

Number of Brothers ____________________________________ Ages _____________

Number of Sisters ______________________________________ Ages _____________

Will you have any brothers or sisters attending college at the same time you are attending

College? ________ Yes _______ No _______ How Many?

Fathers Occupation _______________________________________________________

Employer _________________________________________________________

Phone Number _____________________________________________________

Mothers Occupation _______________________________________________________

Employer _________________________________________________________

Phone Number _____________________________________________________

Do your parents own a business? ___________ yes ___________no

Do your parents own farm or ranch property? ________ yes __________no

Owned ____________ Leased ________

Number of acres ________________________

List any agricultural enterprises__________________________________

__________________________________

College Plans

University or college you plan to attend _______________________________________

Will you live: ___________ at home _________________ dorm ____________ Apt

Degree in which you plan to major ___________________________________________

Have you been formally accepted by this school? ________________________________

State the reason you plan to study in this field. Be specific.

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Career Plans

What is your current preferred career choice? __________________________________

Why did you choose this career? ____________________________________________

________________________________________________________________________

________________________________________________________________________________________________________________________________________________

Did your 4-H /FFA experiences have any influence in your choice? ____ Yes _____No

If yes, explain. ___________________________________________________________

________________________________________________________________________________________________________________________________________________

Record of FFA/4-H Experiences

Number of years enrolled in FFA___________________________________________

Name of Chapter ________________________________________________________

Number of years enrolled in 4-H ____________________________________________

Name of Club ___________________________________________________________

List projects, years involved, and results or related activities:

YEAR PROJECTS ACTIVITIES, RESULTS___

List any judging, Demonstration, Exhibit Contest, Events you participated in

YEAR PROJECTS RESULTS, LEVELS___

Record of FFA/4-H Experiences (continued)

List all Leadership roles you have filled or assisted with:

YEAR ROLE LEVEL( CLUB, CHAPTER, DISTRICT, REGIONAL, STATE

List all citizenship/community service projects you have been active in:

YEAR ACTIVITY YOUR ROLE LEVEL_______

Record of FFA/4-H Experiences (continued)

List the most important honors/awards received in 4-H/FFA:

YEAR HONOR/AWARD LEVEL_______

Why do you consider these honors to be the most important to you? Be specific.

________________________________________________________________________

School, Church and Community

List the Leadership Roles/Activities you have completed outside 4-H/FFA.

YEAR ORGANIZATION/ACTIVITY OFFICE OR ROLE

Summarize major high school honors not previously listed. Do not repeat:

YEAR HONOR/AWARD LEVEL______

Describe the contributions you have made in your community through citizenship or other service projects._____________________________________________________

_______________________________________________________________________

Scholastic Record

(To be completed by High School Principal)

Applicant_____________________________________________________________

Date to be graduated ____________________________________________________

Number in graduating class__________________

Applicants rank in graduating class____________

(Example: 10^th in class of 120)

Numerical High School grade average:__________

College entrance exam—SAT or ACT Score _____________

Was applicant in accelerated classes?____________________

Brief statement by high school principal regarding applicant:

_______________________________________________________________________

*****A Complete Transcript must also be provided and attached to this application*****

Narrative

Write on this page (no longer) a narrative about yourself. Include importtant facts and character traits the selection committee should know. Try not to repeat information already stated in application. This should help the committee get to know you.

CERTIFICATION

I HEREBY CERTIFY THAT THE INFORMATION SUBMITTED IN THIS APPLICATION IS CORRECT.

SIGNATURE OF APPLICANT:__________________________________________

DATE:________________________________

I HEREBY CERTIFY THAT THE INFORMATION PRESENTED BY THE APPLICANT IS CORRECT TO THE BEST OF MY KNOWLEDGE AND THAT THE APPLICANT IS CURRENTLY ENROLLED IN 4-H OR FFA. I DO RECOMMEND THE APPLICANT FOR THIS SCHOLARSHIP

SIGNATURE OF COUNTY EXTENSION AGENT OR AGRICULTURAL SCIENCE TEACHER:

__________________________________________________________ Name

__________________________________________________________ Title

__________________________________________________________ Date