ElecTel Scholarship Application

ElecTel Scholarship Application

Please print or type all requested information. Only complete applications will be considered.
APPLICANT INFORMATION
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*
Email*
example@example.com
PARENT/GUARDIAN INFORMATION
Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone Number*
Email*
example@example.com
Number of other dependent children (excluding yourself)
EDUCATION INFORMATION
High School*
Graduation Date*
GPA*
Name of accredited post-secondary school you attend or will attend*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Anticipated Annual Cost*
2-Year Community/Junior College4-Year College/UniversityVocational/Technical School
ACTIVITIES INFORMATION

List all activities (school and community) in which you have participated, listing any awards or honors received.

Rows	Name & Description of Activity	Awards/Honors Received	Years Participated	Faculty Advisor
1
2
3
4

You may attach a separate sheet if necessary.

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EMPLOYMENT INFORMATION

List all jobs you have held, and include supervisors who can verify your employment. Briefly describe your responsibilities and hours worked per week.

Rows	Employer	Supervisor	Responsibilities	Employment Dates	Hours per Week
1
2
3

You may attach a separate sheet if necessary.

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ESSAY

Please attach a written essay (approximately 500 words) that includes the following:
1. Significant facts about you and your family. Families can include parents, grandparents, sibling, guardians,
  relatives, and/or friends.
2. The course of study you are planning to follow.
3. Share your long range personal and career goals.
4. Why this scholarship would be important to you.
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APPLICATION CHECKLIST
Primary Member Account NumberApplication FormEssayHigh School Transcripts*
*Must be sent to Scholarship Selection Committee under a separate cover. Please mail to:

ElecTel
ATTN: ElecTel Scholarship
3400 Sumner Blvd.
Raleigh, NC 27616
SIGNATURE
I, the applicant, certify that the information provided in this application is complete and accurate to the best of my knowledge. I also agree to allow ElecTel Cooperative Credit Union to promote the scholarship award by printing my photo and name in materials and publications they choose, should I be chosen to receive the scholarship.*

Clear
Date*

MonthDayYear
Date
Should be Empty:

ElecTel Scholarship Application

APPLICANT INFORMATION

PARENT/GUARDIAN INFORMATION

EDUCATION INFORMATION

ACTIVITIES INFORMATION

EMPLOYMENT INFORMATION

ESSAY

APPLICATION CHECKLIST

SIGNATURE