2023 Leadership Summit
Oklahoma State Fair Grounds (Barn 3 Pavilion)
Applications due February 1, 2023
Student Information
Please fill out the entire form to be considered.
Student Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
High School
*
Student Email
example@example.com
Student Cell Phone
-
Area Code
Phone Number
Parent/Guardian
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Emergency Contact Number
*
-
Area Code
Phone Number
I am available to attend the 2023 Oklahoma's Electric Cooperatives Leadership Summit on Monday, March 13, 2023, at the Oklahoma State Fairgrounds in Oklahoma City, OK.
*
Yes, I am available.
I will need transportation provided by Alfalfa Electric Cooperative, Inc. on March 13, 2023, to Oklahoma City.
*
Yes, I will need transportation.
No, I do NOT need transportation.
Student Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Applicant Information:
Gender
*
Please Select
Male
Female
Age
*
Date of Birth
*
Current Grade Level
*
Please Select
Senior
Other
Current GPA
*
Student Long Sleeve Shirt Size
*
Small
Medium
Large
X-Large
2X Large
3X Large
What are your post-high school plans? What fueled you to pursue these plans?
*
0/200
Have you received any honors/awards? List your top 3 below.
*
0/200
Please list your most significant community leadership activities:
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0/200
What is the best piece of advice you have ever received?
*
Describe yourself in three words.
*
0/200
Is there anything else we should know about you?
*
0/200
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Reference Information
Reference Name
First Name
Last Name
Relationship to applicant
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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