Youth Scholarship Application

Youth Scholarship Application
(Must be a Senior in High School to Apply)

Applicant’s Name*

Address*

City*

State*

Zip*

County*

Phone Number*

Email*

Gender*

Female

Male

Name of School*

Are you currently enrolled as a Senior in high school?*

Yes

Parent Information

Father's Name*

Father's Email*

Mother's Name*

Mother's Email*

Guardian's Name (If not living with Father/Mother)

Guardian's Email

Midwest Energy Account Number*

Applicant Signature

Selection will be made without regard to the applicant's race, color, ethnicity, religion, gender, or physical handicap. Ten winners will be selected for $1,000 scholarships. Selection is based on the completed application. Children of Midwest Energy employees are not eligible to apply.

I certify that this information is true, complete and accurate. I authorize release of information to confirm and/or verify this application. I further authorize release of my name in connection with announcements of scholarship awards in the event that I am selected to be a Midwest Energy, Inc. Youth Scholarship recipient.

Applicant’s Signature*

Date*

Questions

List organizations or clubs in which you have participated.*

What offices have you held in which organizations?*

What honors or awards have you received?*

List your hobbies, talents, and special interests.*

Describe any volunteer experience you have.*

What, if any, work experience do you have?*

What are your future educational and career goals?*

Please write a paragraph describing how you believe your career goals can be realized if you choose to return to central or western Kansas?*

At Midwest Energy, we value safety, service, stewardship, integrity, innovation, collaboration, and a focus on community. Pick one of these values and explain in a paragraph how you exemplify that trait.*