2027 Children of Members Scholarship Application

Name

Phone

Street Address

City

State

Zip Code

Student Email

Parent Email

Parents' Names

Parents' Phone Numbers

Age

Birthdate

Name of High School

By which college(s) have you been accepted?

Major(s)?

Non-School Personal Achievement

Give years of membership and outstanding activities in which you have participated as a leader.

Re-order	Activity	# of Years	Remarks	Weight	Operations
	Activity	# of Years	Remarks	Item weight

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School Activities Personal Achievement

(Such as class officer, plays, athletics, music, etc.)

List the most prestigious activities participated in during your high school attendance.

Re-order	Activity	# of Years	Remarks	Weight	Operations
	Activity	# of Years	Remarks	Item weight

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Personal Achievement

Other

List all other activities heretofore not mentioned which will more fully describe your past achievements, including any work experience.

Re-order	Activity	# of Years	Remarks	Weight	Operations
	Activity	# of Years	Remarks	Item weight

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High School Transcript

Attach high school transcript of applicant and signed by school official. Since grade point scales vary by district, please provide a brief explanation of your school’s grade point scale (e.g. “out of a possible 4.0”) or include a copy and /or description of the scale with the transcript.
One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

Teacher Reference Letter

One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

List Scholastic and Community Awards Won

Local, county, district, or state

Statement of Applicant, Parent or Guardian

We have examined this application and the records are true, complete and accurate. In addition, we acknowledge and agree that the Holmes-Wayne Electric Cooperative, Inc. may disclose any or all of the information contained in this application and the supporting documents to the judges of the scholarship competition.

Date

Applicant's Signature

Sign above

Parent/Guardian's Signature

Sign above