This onetime $300.00 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
Applications must be received in the Jefferson County Extension Office by April
1, 2012 to be considered for the 2012-2013 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.
Phone Number: __________________
- Name : ______________________________________________________________________
- Parent’s name: ________________________________________________________________
- Address: _____________________________________________________________________
- High School : ____________________________________ Principal : ____________________
- Age: ______ Birth date: _____________ Sex: _______ Graduation Date: __________________
- Father’s Occupation/business address: ______________________________________________
- Mother’s Occupation/business address: _____________________________________________
- Name / address of Guardian if other than mother/father: ________________________________
- Name of College you plan to attend: _________________________________________________
- Are you a member of/ or related to a member of Herbs for Health and Fun Club?
- If yes... Name of Member _____________________________
- If not a member, list name (s) of member that you are related to, _____________________________
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
Please return by April 1, 2012 to:
Jefferson County Extension Office
% Herbs for Health and Fun Club
Mt. Vernon, Illinois 62864
Herbs for Health and Fun Club Scholarship
Download and print Scholarship form PDF file