Walter Harrison Scholarship

Walter Harrison Scholarship Application

Carroll EMC selects one semifinalist from its service area to compete at the state level for a $1,000 Walter Harrison Scholarship. Judges select winners each year based on financial need and academic ability.
Name*

First NameLast Name
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from home address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Last 4 digits of SSN*
Applicant's Electric Cooperative

Carroll EMC

If you are an adult/non-dependent, please provide your place of employment.
NOTICE: Parental information is not required of adult, non-dependant applicants.
If adult applicant is married, spouse’s information must be included below.
Father's Name

First NameLast Name
Father's Phone Number

Area CodePhone Number
Father's Place of Employment
Mother's Name

First NameLast Name
Mother's Phone Number

Area CodePhone Number
Mother's Place of Employment
Spouse's Name

First NameLast Name
Spouse's Phone Number

Area CodePhone Number
Spouse's Place of Employment

Please attach the following documents:
Acceptance Letter*

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Acceptance letter or other evidence to confirm admission to a Georgia college or technical school. If student is not yet accepted this information will be required at the time the scholarship is awarded. Cancelof
Autobiographical Sketch*

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Two-page autobiographical sketch with reference to future plans and goals as well as your involvement in the community. Do not reveal your name, the name of your cooperative or your place of residence in the bio, as any such references will be marked out before being submitted to the judges, which will not make for an attractive, readable document. Cancelof
Academic Transcript*

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High school transcript or current college/technical school transcript (unless student graduated more than 10 years ago). Cancelof
S.A.T./A.C.T. Score*

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S.A.T., A.C.T score. If you did not take the S.A.T. or A.C.T., you may submit an ACCUPLACER score. Cancelof
Letter of Recommendation (1)*

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Letter of Recommendation (2)*

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Cancelof

Financial Need Assessment

NOTICE: Proof of financial information submitted may be required if scholarship is awarded. Will be handled as strictly confidential information.
Total Adjusted Gross Income for Household (from most recent income tax return)*
Other Household Income*
Number of Family Members Residing in Household*
Other Factors Which Influence Financial Need*

I certify that all information reported on this application is true and correct to the best of my knowledge.*

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
Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Walter Harrison Scholarship Application