2022 Lineman School Scholarship Application

2022 Lineman School Scholarship Application
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Date of birth *

Month Day Year
E-mail *
Phone Number *

Area Code Phone Number
Have you applied to lineman school? *

Yes No
If so, where?
Have you been accepted to lineman school? *

Yes No
If so, where?
Start Date

Month Day Year
Are you related to any employee, retiree, foundation trustee or director of CEMC? *

Yes No
If so, who and what is the relationship?
Have you been convicted of a felony? *

Yes No
Name of high school *
Graduation/GED Date *

Month Day Year
Most recent work experience:
Current employer
Position
Date of employment

Month Day Year
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
References:

Please provide 3 character, personal or employment references of which we may contact.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
May we contact your references? *

Yes No
Recommendation letters (one professional, one personal)
Professional Recommendation letter

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Cancel of
Personal Recommendation letter

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Cancel of
How did you hear about this scholarship? *
Household or family income as listed on most recent year's tax return $
250-500 word essay explaining "Why I want to be a lineman"

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Cancel of
I certify that all information reported on this application is true and correct to the best of my knowledge. I also agree to submit a certificate of completion at the end of the lineman training to Carroll EMC. *

Yes
I grant permission to Carroll EMC to use my images or videos for communication and publicity purposes. I grant permission to Carroll EMC to text/or call me via the cell phone listed on this from. *

Yes
Date *

Month Day Year
Should be Empty: