Cooperative Scholarship Application

Please read through the entire application before you begin to ensure you have all the necessary information and attachments. You will not be able to save work and return at a later time. To download a PDF of the application, click here.
GUIDELINES

• Applicants must live in a household (main residence) served by Tri-County EMC.

• Recipient must already be enrolled in an accredited full or part-time program.

• Recipient must be an undergraduate student only.

• The scholarship will be a grant paid to the college, university or vocational school.

• Previous winners are not eligible for a second scholarship.

• Funds can be used at any U.S. accredited college, university, vocational or technical school.

• One $2,000 scholarship will be awarded to each district. A total of three $2,000 scholarships will be issued.

• Student must use the scholarship within one year of issuance, and it must be completely used within two years of issuance date. The school shall return any unused funds to us.

• Applications are judged based on academic ability, financial need and community contributions.

• Applications are scored by an independent panel of judges.

• Essay must be a 500-750 word, typed autobiographical sketch referencing plans and goals while indicating a concern for community.

CHECKLIST

For a complete application, students must submit the following:
- an acceptance letter or proof of enrollment for their college
- a 500-750 word essay
- two letters of recommendation
- most recent high school or collete transcript

Student Contact Information
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Cell Phone

Area CodePhone Number
Home Phone

Area CodePhone Number
College Student ID #, if available

Parent/Legal Guardian Information
Parent/Legal Guardian Name

First NameLast Name
Legal Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Legal Guardian Phone Number

Area CodePhone Number
Legal Guardian Email Address

Attachments
You can upload each document separately using the fields below, or you can upload all files as one document using the last field at the bottom of this page.
Acceptance Letter or Proof of Enrollment to College or Technical School

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High School or College Transcript

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A 500-750 word typed, autobiographical sketch referencing future plans and goals, indicating an overall sense of community spirit.

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Official Documentation of Most Recent SAT or ACT Score

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1st Letter of Recommendation

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2nd Letter of Recommendation

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Any Additional Information

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If you would rather upload all of your necessary files as one document, please use the next field.
All Attachements Included in One Document

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Academic Performance and Potential
High School or College Average (100 Point Scale)
SAT Score
ACT Score
Please use the fields below to describe your involvement in your school and community.
Participation in Community Enrichment Activities
Membership in Organizations
Offices Held in Organizations
Honors and recognition received
Extracurricular Involvement (ex: Sports, band, etc.)
College or Technical School to which you have been accepted
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
College Status

Senior in High SchoolFreshmanSophomoreJuniorSenior
If you are a high school senior, when do you plan to start college?
School Tuition
Is this the tuition per quarter or semester?

Per QuarterPer Semester

Financial Need Assessment
Answer the next two questions refering to the prior year's income tax return.
Total adjusted gross income of parents/guardian
Other Non-taxable income
Number of Family Members Living in Household
Number of Family Members Currently Attending College or Technical School (other than yourself)
Annual cost per family member attending school
Are there any other factors that influence your financial need?

By signing, I certify that all the information on this application is true and correct to the best of my knowledge.
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