Children of Members Senior Scholarship

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Student Information

Student First Name

Student Last Name

Student Phone

Birth Date

Student Mailing Address

Student City

Student State (Two Letter Abbreviation)

Student Zip Code

Student Email

Name of High School

Official School Transcript

One teacher recommendation letter (No more than 500 words)

Scholastic Record (click to download) completed by school official

High resolution photo of student (by uploading this you acknowledge consent for PPEC to publish this image)

Record Type ID

Parent/Guardian Information

First Name of Parent or Guardian

Last Name of Parent or Guardian

Additional Name of Parent or Guardian

Parent Phone

Parent Mailing Address

Parent City

Parent State (Two Letter Abbreviation)

Parent Zip Code

Parent Email

PPEC Account # (found on your bill)

College Information

What college(s) or accredited technical school(s) have you been accepted?

Did you declare a major, and if so, what?

NON-SCHOOL PERSONAL ACHIEVEMENTS:

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

Activity

Number of Years

Remarks

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Number of Years

Remarks

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Number of Years

Remarks

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Number of Years

Remarks

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Activity

Number of Years

Remarks

SCHOOL ACTIVITIES PERSONAL ACHIEVEMENTS:

List the most prestigious activities participated in during your high school attendance. Such as class officer, plays, athletics, music, etc.

Activity

Number of Years

Remarks

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Activity

Number of Years

Remarks

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Number of Years

Remarks

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Activity

Number of Years

Remarks

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Activity

Number of Years

Remarks

PERSONAL ACHIEVEMENTS:

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

Activity

Number of Years

Remarks

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Activity

Number of Years

Remarks

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Activity

Number of Years

Remarks

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Number of Years

Remarks

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Activity

Number of Years

Remarks

STUDENT ACKNOWLEDGEMENT

I (student) have examined this application, and the records are true, complete, and accurate. In addition, I acknowledge and agree that the Cooperative, Ohio’s Electric Cooperatives, Inc., and Indiana Electric Cooperatives may disclose any or all of the information contained in this application and the supporting documents to the judges of the competition and to any employees of the Cooperative or of Ohio’s Electric Cooperatives, Inc. and Indiana Electric Cooperative.

I also consent and agree that Paulding Putnam Electric Inc. (PPEC), its employees, and agents have the right to take photographs, videotape, or digital recordings of me to use in any and all media. I agree that PPEC may use such photographs and media of me with or without my name and for any lawful purpose, including, for example, such purposes as publicity, illustration, advertising, web content, and the cooperative's magazines.

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First Name

Last Name

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