This onetime scholarship is offered each year to any student entering a program leading to a degree/certification for a career or profession in Horticulture. Graduating seniors are encouraged to apply, and the non-traditional student will also be given consideration. It is not necessary that the applicant be affiliated with Herbs for Health and Fun Club; however, this will be an additional favorable factor. Students interested in continuing their education are encouraged to apply. Information relative to the scholarship may be obtained by calling, Ernie Henson 618-822-6584 .

 

Applications must be received in the Jefferson County Extension Office by April 1, to be considered for the academic year. The completed application is to be returned to the Jefferson County University of Illinois, 4618 Broadway, Mt. Vernon, IL 62864.

 

Type/print the information requested and use additional sheets of paper if necessary. You and your parents/guardian must sign this form.                               

                                                                                                Date: __________________________

                                                                                                Phone Number: __________________

Title page:

  1. Name : ______________________________________________________________________

(Last)                                                  (First)                          (Middle)

  1. Parent’s name: ________________________________________________________________

(Last)                                                  (First)                          (Middle)

 

  1. Address: _____________________________________________________________________

(Street)                                                (City)                          (Zip code)

  1. High School : ____________________________________ Principal : ____________________

 

Address: ________________________________________ Telephone: ___________________

 

  1. Age: ______ Birth date: _____________ Sex: _______ Graduation Date: __________________

 

  1. Father’s Occupation/business address: ______________________________________________

 

  1. Mother’s Occupation/business address: _____________________________________________

 

  1. Name / address of Guardian if other than mother/father: ________________________________

___________________________________________________________

 

  1. Name of College you plan to attend: _________________________________________________

 

  1. Are you a member of/ or related to a member of Herbs for Health and Fun Club?     

 

  1. If yes... Name of Member _____________________________

 

  1. If not a member, list name (s) of member that you are related to, _____________________________

 

 


Part Two:

Essay to include these items, but not limited to:

Ø  Career Objectives

Ø  Reason for choosing this career

Ø  Leadership, offices held and extra-curricular activity during the past two years

Ø  Prizes, awards, honors, scholarships and other recognitions received.

Ø  List paid work experiences and volunteer work experiences

Ø  Letter of reference from someone other that school personnel or teacher/or parents /guardian.

Ø  Include a recent photo

Essay is not to be less than 300 words or no more than 500 words.

 

I certify that to the best of my knowledge all information included in this application and essay is true and correct and I, applicant, am solely responsible for preparation of the essay. I hereby grant permission for the Selection Committee to contact my high school to verify any and all information on this application.

 

________________________________                                ________________________________

Signature of Applicant                                                           Signature of Parent/Guardian

 

If Graduating High School Student, complete the following. If not request a copy of your transcript from the last educational institution attended is submitted to the Selection Committee to be added to this application.

 

Please have the appropriate school official fill in the information and attach a high school transcript with the application.

 

_______________________________________                  ________________________

Signature / Title of School Official                                       Date

 

 

Please return by April 1, 2012 to:

Jefferson County Extension Office

% Herbs for Health and Fun Club

4618 Broadway

Mt. Vernon, Illinois 62864

 

Marked:

Herbs for Health and Fun Club Scholarship