2024 Cooperative Trade Scholarship Form

1. Are your parents/guardians permanent residential members of Lorain-Medina Rural Electric Cooperative

Yes

2. Have you received a "Full Ride" scholarship to the school of your choice?

Yes

3. Are members of your family, or persons residing in your household, employed by, or a trustee of, ANY electric cooperatives/related entities?

Yes

If you answered NO to the first question, and/or answered YES to the second or third questions - Thank you for your interest in our scholarship, but you do not qualify.

Full Name

Phone Number

Date of Birth

Age

Gender

Male

Female

Mailing Address

City

State

Zip Code

Student Email

Parent Email

Are your parents/guardians members of Lorain-Medina Rural Electric Cooperative?

Yes

Parents' Names

Service Location Address

Parent(s) Phone Number

Parent(s) Cell Phone Number

Name of School

Grade

School Address

Select all that apply

I plan on pursuing a two-year accreditation

I plan on pursuing my certification from a technical college

Name/title of program that I plan on attending:

Field of interest:

NON-SCHOOL PERSONAL ACHIEVEMENT

Indicate years of membership and outstanding activities in which you have participated as a leader.

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SCHOOL ACTIVITIES PERSONAL ACHIEVEMENT

List the most prestigious activities participated in during your high school attendance, including any school or trainings you have already completed towards your desired field.

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PERSONAL ACHIEVEMENT

List all other activities not mentioned that more fully describe your achievements, including work experience.

SHORT ANSWER QUESTIONS

Why do you plan on pursuing your education in this field?

How will you use your intended career path and training to benefit your community?

ATTACHMENTS

Official School Transcript (must be signed by my guidance counselor)

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

One letter of personal reference from a teacher or member of the community

One file only.
20 MB limit.
Allowed types: txt, pdf, doc, docx, ppt, pptx, odp, xls, xlsx, ods.

One recent photo of the applicant

One file only.
20 MB limit.
Allowed types: gif, jpg, png, svg.

STATEMENT OF APPLICANT, PARENT OR GUARDIAN

We have examined this application, and the records are correct, complete and accurate. In addition, we acknowledge and agree that the cooperative may disclose any or all of the information contained in this application and the supporting documents to the judges of the scholarship competition and any employees of the cooperative or of Ohio’s Electric Cooperatives. Winners’ names and photos will be published in Ohio Cooperative Living magazine, and may also be used on social media or in other co-op publications.

I consent and agree that Lorain-Medina Rural Electric Cooperative (LMRE), its employees, and agents have the right to take photographs, videotape, or digital recordings of me to use in any media. I agree that LMRE may use such photos and media of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, web content and the Ohio Cooperative Living magazine.

Date

Applicant's Signature

Sign above

Parent / Guardian's Signature

Sign above