Ohio
Rural Electric Cooperatives, Inc. |
Scholarship
for Children of Members |
In cooperation with Pioneer Electric Cooperative Date:
APPLICATION
FORMS MUST BE TYPED |
(Forms must
be mailed to your Cooperative when completed.) |
Mailing Address:
Location Address:
Parents' Names:
Are your parents/guardians members of an electric cooperative? Yes No
Name of School:
School Address:
By what college or accredited technical school have you been accepted?
What will be your major or degree?
PERSONAL ACHIEVEMENT: (Non-School Activities including
church & community)
Give years of membership and
outstanding activities in which you have participated as a leader.
Organization |
No. of Years |
Offices
Held |
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PERSONAL ACHIEVEMENTS: (School Activities)
List the activities you participated in during your high school
attendance such as: Class officer, plays, athletics,
music, etc. Don't
list them all; select the most prestigious.
| Activity |
No. of Years | Remarks |
| | | |
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Personal Achievement: (Other)
List all other
activities not previously mentioned which will more fully describe your past achievements,
including
any work experience. (5 lines Maximum)
We have examined this application and the records are true, complete and accurate.
| Date: | ______________ | Signed: | _______________________ |
|
(Applicant) | |||
| Signed: | _______________________ | ||
|
(Parent or Guardian) |
(These signatures are to be affixed prior to forwarding the application to the high school officials.)
Scholastic Record:(To
be completed by high school principal or counselor and maybe handwritten)
High school scholastic record by years: Attach transcript of applicant's
grades signed by school official. Applicant information must be confined
to the official nomination form with no attachments other than grade transcripts.
Number in Senior Class: Girls Boys
Class Rank: Junior year Senior Year
List Scholastic awards won: (Local, county, district or state) (80 characters Maximum if typed in)
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Cumulative Point Hour (On 4.00 Scale)
Cumulative Point Hour (On weighted scale, if applicable)
ACT Composite
(American College Test)
PSAT-NMSQT Standing
(National percentile ranking)
(Preliminary Scholastic Aptitude Test-National Merit Scholarship Qualifying Test)
Signed:________________________________ Position:_________________________________
(To be completed by instructor in this year
of school and maybe handwritten)
Evaluation of student: (Leadership, perseverance,
prediction of success at university, etc.)
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signed:____________________________________ Position:____________________________
High School:________________________________ Address:____________________________
(This part to be filled in by judges)
PERSONAL INTERVIEW:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
COOPERATIVE KNOWLEDGE:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
| TOTAL POINTS: | Attach Photo Here |
___________________ Scholastic Record
___________________ Personal Achievement
___________________ Personal Interview
___________________ Cooperative Knowledge
| ________________________________ | |
| Student's Name |