2021 West Florida EC Youth Tour Application

2021 West Florida EC Youth Tour Application

Please complete & return by Jan. 20, 2021
COVID-19 Announcement

*Due to COVID-19, the annual trips to Tallahassee and to Washington, D.C. have been canceled for 2021. However, West Florida Electric Cooperative will award four (4) $4,000 scholarships to Chipola College to Youth Tour participants. Based on interviews, which will be conducted with each student virtually, one scholarship will be awarded to the highest scoring Youth Tour participant from each county.
Name

First Name Last Name
Name you wish to be called:
Age:
Gender:
Name of parent or guardian:
West Florida EC account number (as shown on bill):
Phone number:

Area Code Phone Number
Best contact number for you:

Area Code Phone Number
Best contact number for parent or guardian:

Area Code Phone Number
Email *
example@example.com
May we send you and your parent/guardian text messages using the Remind App?
Student birthday:

Month Day Year
Date
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
High School:
Principal:
Guidance Counselor:
Special dietary needs/requests: (vegetarian, allergies, etc.)
Community activities/involvement: (volunteering, church, etc.)
Community activities (continued):
Hobbies/extra curricular activities:
School activities:
Awards/accomplishments:
Career goals/major interest of study:
Write a brief profile of yourself - talk about your family, favorite subjects, hobbies, career objectives, accomplishments, etc. *
Should be Empty:

COVID-19 Announcement