2024 LMRE Youth Day Application

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

Yes

2. Are you currently a sophomore or junior in high school?

Yes

Full Name

Phone Number

Age

Birthdate

Street Address

Township

City

State

Zip Code

Student Email

Parent Email

Parents' Names

Parents' Phone Numbers

Name of High School

Address of High School

T-shirt Size

SHORT ANSWER QUESTIONS

If you could ask one question to a state representative, what would it be and why?

What is the difference between an electric cooperative and other electricity providers?

How did you find out about Cooperative Youth Day?

Attachments:

One teacher recommendation (no longer than 500 words)

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 true, 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 selection committee for the Youth Day program and to any employees of the Cooperative.

Date

Applicant's Signature

Sign above

Parent / Guardian's Signature

Sign above