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 Application o 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 Won State Project Level I: Advanced Project Level II: List Year Won State 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) Points Scor e 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