2023 Energy Camp Application
Energy Camp | May 30 - June 2, 2023
DEADLINE: FEBRUARY 7, 2023
Please fill this application out in full.
Local Electric Cooperative
Please Select
Alfalfa
Student Name
First Name
Last Name
Student Email
example@example.com
Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
Please enter a valid phone number.
Student Gender
Male
Female
Student Date of Birth
-
Month
-
Day
Year
Date
Student School:
Student Age as of June 1, 2023
Student T-shirt Size
Small
Medium
Large
XL
2XL
3XL
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Parent/Guardian Email
example@example.com
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Parent/Guardian #2 Email
example@example.com
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LEADERSHIP SURVEY
What kind of leader are you? What activities are you interested in?
What activities are you involved in at school and within your community?
What leadership skills have you learned by being involved in these activities?
What are your Top 3 accomplishments? Which is the most important to you and why?
Hobbies, Talents & Special Interests
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YouthPower Energy Camp Application
YouthPower Energy Camp is designed to help develop leadership skills, have summertime fun, and at the same time learn about one of rural America's most important industries - rural electrification.
What kind of leader are you?
What or Who inspires you?
Why do you want to attend Energy Camp?
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Student Reference
Alfalfa Electric Cooperative is looking for students who will represent our co-op and your school in a positive manner. Please provide one reference (that you have permission from) for us to contact on your behalf. Please provide a reference outside of your English teacher.
Name
First Name
Last Name
Job Title
Example: School Administrator or Teacher
Email
example@example.com
Application Agreement
*
I CONFIRM I am able to attend the 2023 Energy Camp on May 30 - June 2, 2023
*
I hereby give permission for images of myself (or child), during the 2023 Energy Camp application process through video, photo and digital camera, to be used solely for the purposes of Oklahoma's electric cooperatives promotional material and publications, and waive any rights of compensation or ownership thereto.
Student Signature
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