APPLICATION FORM FOR:	BUTLER COMMUNITY COLLEGE 4-H SCHOLARSHIP
Please circle the scholarship(s) 
	you are applying for.	E. W. NATH 4-H SCHOLARSHIP
Name       
Address       
4-H Club       
Parent’s Name       
Father’s Occupation       	Mother’s Occupation       
List brothers and sisters at home or receiving financial support from parents (please give name and age):
	     
Will any siblings be in college next year     Yes            No       
Estimated Expenses and resources for the next college year:
		Expenses	Resources
	Enrollment Fees	$     	Personal Savings	$     
	Books and Supplies	$     	Net earnings during vacation
	Board	$     	  available to apply on expenses	$     
	Room	$     	Part-time earnings during
	Clothing	$     	  school year	$     
	Lunches and travel expenses		Aid from parents or guardian	$     
	  for commuting students	$     	Aid from other relatives	$     
	Insurance premiums—life, car		Scholarships	$     
	  health	$     	Other resources (specify)	$     
	Person and recreation	$     
	Other costs (specify)	$     
	Total	$     	Total	$     
Net amount necessary to balance anticipated budget  $     
High School Attended       		Last Year Completed       
College Attended       		Years Completed       
Number in High School Class       		Your Rank in Class       
If in College, Grade Point Average       		(A=         Points)
When do you plan to attend college       		Where       
In what course do you plan to major in (field of study)       
What scholarships have you received       
What other scholarships have you applied       
4-H record book (see guidelines) and high school transcript must be submitted with this application.
4-Hers Signature__________________________________________________________________________
Parent Signature__________________________________________________________________________