Youth TourApplication

Record Type

To apply, please follow these three steps:

Fill out the application.
Attach the required documents:
- Essay on the topic: "What would life be like without electricity? How does it add value to our lives?"
  Essay should be in MLA style and cite references. Essays must be 300-500 words and submitted in Word or PDF format.
- A recent color photo.
  NO selfies or photos with filters will be accepted.
- Legal guardian documentation
  If applicable.
Click "Submit Form."

Important Requirements

To be considered for the program, you must meet the requirements and submit the required essay.
For detailed instructions, eligibility, essay and specific photo requirements, visit MedinaEC.org/YouthTour.

For any questions, please email YouthTour@MedinaEC.org.

Applicant Information

First Name:

Last Name:

Date of Birth:

Phone Number (include area code):

Email Address:

Mailing Address:

City:

State:

Zip Code:

Youth Tour Questionnaire

Why are you applying to go on the Youth Tour Trip?

What part of the trip are you looking forward to the most?

School & Involvement Information

High School or Homeschool Association

Grade

School Activities

List any school-related activities you have participated in and any special honors you have received during your high school career, such as class officer, music, athletics, etc. Include the activity, the years you participated, and any relevant remarks.

Extra-curricular Actvities

List any activities you have participated in, such as 4-H, FFA, church, community service clubs, etc. Include activity, the years you participated and any relevant remarks.

Future College Major of Interest

Career Goals

Parent/Guardian Information

Note: Information is required for at least one parent/legal guardian.

Relationship to Applicant

Parent Name/Legal Guardian's Name

Relationship to Applicant

Parent Name/Legal Guardian's Name

Email Address:

Phone Number (include area code):

Account Information

Account Holder's Relationship to Applicant:

Note: If not the parent, the Legal Guardian must submit appropriate documentation (see checklist below for file upload tool).

Enter your Medina Electric ACCOUNT #

Enter your Medina Electric MEMBER #

Account Holder's First Name

Account Holder's Last Name

Account Holder's Email

Account Holder's Phone

How did you hear about the scholarship program?

If "Other" is selected above, please indicate the source here

Other Source:

Documentation

Essay requirements are at the top of this page.

Essay Submission

Photo: JPEG or PNG acceptable. Do not send photos of your drivers license.

Photo

If the applicant is not the child of the account holder, please provide documentation showing the relationship.

Legal Guardianship

Acknowledgement and Authorization

I understand that by signing this document or typing a digital signature that I am affirming that the information provided on this application is true and complete to the best of my knowledge. I understand and agree that any falsified information or significant omissions will disqualify me from further consideration for this scholarship and, if discovered after disbursement, will result in repayment of funds. I agree to authorize Medina EC to use my name and/or image for promotional purposes. I agree to permit the review of this application and my school records by anyone representing the Medina EC Scholarship program.

Type your full name as your digital signature

Applicant's Signature:

Required only if applicant is under 18. Type parent/guardian's full name as digital signature.

Parent/Guardian Authorization Signature (if applicant is under the age of 18):