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APPLICANT INFORMATION
Full Name
Last 4 digits of SSN
Applicant Information
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Email
Phone
ACCOUNT INFORMATION
LCEC Account No.
Cooperative Account Holder's Name
Relationship of Account Holder to Applicant
Parent / Legal Guardian Phone
EDUCATION INFORMATION
Name of High School Attending
City
Date of Graduation
GPA
I Have taken the SAT
Yes
No
If Yes, what was your score?
I Have taken the ACT
Yes
No
If Yes, what was your score?
College or Vocational School in which you plan to attend
Office of Registrar's mailing address
Office of Registrar's mailing address
Address
City/Town
State/Province
- None -
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP/Postal Code
Anticipated Course of Study (Major)
Type of degree
4-Year Bachelor's Degree
2-Year Associate Degree
Please Attach The Following:
1. High School Transcript (MUST be signed by a School Administrator)
2. ACT or SAT score verification
3. Please attach a list of all school extracurricular, church, community, civic, work and/or volunteer activities that you desire to be considered in your application.
4. One (1) Letter of Recommendation is suggested.
5. Essay - Attach a 250-word typed essay on who are you and what are your personal and educational goals.
6. Current Photo
Attached Documents
Unlimited number of files can be uploaded to this field.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.
CERTIFICATE
I certify that this information contained in this application is true, complete and accurate. I agree to permit the review of this Application and my school records by anyone representing Lea County Electric Education Foundation. I authorize the release of information to confirm and/or verify this application. I further authorize the release of my name and photos in connection with announcements of scholarship awards in the event that I am selected to be a scholarship recipient. I understand that this scholarship is good only for full-time students pursuing an Associate or Bachelor’s degree. The scholarship funds are only applicable towards undergraduate degree only.
We, the undersigned individuals, the applicant and a parent/guardian of the applicant, by signing below authorize the release of any and all academic information from and do hereby authorize the guidance counselor and principal of such high school to discuss such information with the LCEC Education Foundation. We, the undersigned, by signing below authorize the release of any and all test scores and other information from the American College of Testing (ACT) or the Stanford Achievement Test (SAT) to the LCEC Education Foundation.
By signing below, we acknowledge that we have each read the entire application package and do hereby certify that we understand the contents of the application package. Also, by signing below, we each certify that the information provided in the application and each of the attachments submitted with the application are true and correct. If any of the information provided in the application or any of the attachments is found not to be true and correct, the applicant will be immediately disqualified and, if any scholarship has been awarded, such scholarship shall be rescinded.
I agree
I Agree
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