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:
		Name	Age	Name	Age
________________________________________________________________________________________
________________________________________________________________________________________
Will any siblings be in college next year?_______________________________________________________
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__________________________________________________________________________