Scholarships Applicant Information Scholarships Available: Testing For New Scholarship Judging *** hold the control key to select multiple. *** First Name: Middle Name: Last Name: Street Address: Street Address 2: City: State: -Select- Kentucky Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Zip Code: Phone Number: Email Address: Date of Birth: Did you grow up on a farm? -Select- Yes No KYFB Membership #: Membership Last Name: Membership County: -Select- Adair Allen Anderson Ballard Barren Bath Bell Boone Bourbon Boyd Boyle Bracken Breathitt Breckinridge Bullitt Butler Caldwell Calloway Campbell Carlisle Carroll Carter Casey Christian Clark Clay Clinton Crittenden Cumberland Daviess Edmonson Elliott Estill Fayette Fleming Floyd Franklin Fulton Gallatin Garrard Grant Graves Grayson Green Greenup Hancock Hardin Harlan Harrison Hart Henderson Henry Hickman Hopkins Jackson Jefferson Jessamine Johnson Kenton Knott Knox Larue Laurel Lawrence Lee Leslie Letcher Lewis Lincoln Livingston Logan Lyon Madison Magoffin Marion Marshall Martin Mason McCracken McCreary McLean Meade Menifee Mercer Metcalfe Monroe Montgomery Morgan Muhlenberg Nelson Nicholas Ohio Oldham Owen Owsley Pendleton Perry Pike Powell Pulaski Robertson Rockcastle Rowan Russell Scott Shelby Simpson Spencer Taylor Todd Trigg Trimble Union Warren Washington Wayne Webster Whitley Wolfe Woodford Student Information School You Plan to Attend: Major: School Type: -Select- University/College Community/Technical College Proprietary/Trade School Are you pursuing a 4-year degree? Yes No Is your major related to Agriculture? -Select- Yes No Are you currently enrolled in any post-secondary education such as college or trade school? -Select- Yes No Career Choice: Level of Course Work: Advanced Honors Basic Other GPA: (do not round) ACT Score: SAT Score: *Unweighted GPA based on a 4.0 scale. Give to the nearest one-hundreth and do not round off. Please attach documentation verifying unweighted GPA, ACT and SAT scores. High School: High School Graduation Year: Date of Awards Night: Counselor: Counselor Phone: *Accepted file type extensions for uploads: pdf, doc, docx, txt, jpg, jpeg, png, rtf, odt Transcript of your high school grades, including unweighted GPA (4.0 scale), ACT and SAT scores: Grading scale for your school: Official copy of your second semester senior schedule: Letter of recommendation describing characteristics such as leadership, citizenship and maturity from school official (e.g. teacher, counselor, principal): Letter of recommendation describing characteristics such as leadership, citizenship and maturity from a non-relative: Essay #1: In 300 words or less, answering the question: "Who is my role model and why?" 0 words Essay #2: In 300 words or less, answering the question: "Why am I pursuing higher education?" 0 words Applicants for the Leadership in Agriculture Scholarship must submit a narrative describing their family farming operation. If a narrative is not submitted, the student will not be eligible for this scholarship. Work Experience Delete Job Job: Hours Per Week: Is this Farm Work: -Select- Yes No Date of Employment: to Present Employer Describe jobs you hold or have held during high school. (Include work on family farm.)*Hours per week are for the school year. Add Job School Clubs and Offices Delete Club/Office Club/Office: Years Participated: FR SO JR SR Office/Leadership position held: President Vice President Treasurer Captain Other Leadership Roles Member List school clubs, offices, organizations, etc. in which you have participated. Add Club/Office Other Extra-Curricular Activities Delete Activity Activity: Time participated (Hours/week): Office/Leadership position held: President Vice President Treasurer Captain Other Leadership Roles Member List church groups, social groups or other extra-curricular activities in which you have participated. Add Activity Did you participate in the Kentucky Governor's Scholar Program? Yes No Did you participate in IFAL (Institute for Future Agricultural Leaders)? Yes No Have you participated in the Outstanding Farm Bureau Youth or Variety contests? Yes No Financial Need Dependent {row} Age: Legal Guardian Name: Legal Guardian Employer: Legal Guardian Occupation: Business Phone: Legal Guardian Taxable Income Last Year: $ *If a second legal guardian is not applicable, fill out N/A, 555-555-5555, and 0 for the following. Legal Guardian Name: Legal Guardian Employer: Legal Guardian Occupation: Business Phone: Legal Guardian Taxable Income Last Year: $ Dependent Children (including applicant): -Select- 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Your scholarship application was submitted successfully!