2024 Touchstone Energy Adversity Scholarship

1. Are your parents/guardians permanent residential members of North Central 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

4. Have you faced an adversity or hardship, outside of work or school obligations, that qualifies you for this scholarship opportunitiy?

Yes

If you answered YES to question 1 & 2) and/or NO to questions 2 & 3) - Thank you for your interest in our scholarship, but you do not qualify.

Full Name

Phone Number

Street Address

Township

City

State

Zip Code

Student Email

Parent Email

Parents' Names

Parents' Phone Numbers

Age

Birthdate

Name of High School

Address of High School

By which college(s) or accredited technical school(s) have you been accepted?

Major(s)?

Discuss the barriers you faced that made it difficult to achieve your goals below.

SCHOOL ACHIEVEMENTS

List the special achievements accomplished during your high school years either related to school activities or other than school activities, including any scholastic awards you may have received.

Re-order	Activity/Achievement	# of Years	Remarks	Weight	Operations
	Activity/Achievement	# of Years	Remarks	Item weight

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NON-SCHOOL ACHIEVEMENTS

List of other accomplishments that show leadership skills, citizenship achievements, work skills, or unique challenges overcome to achieve an education.

Re-order	Activity/Achievement	# of Years	Remarks	Weight	Operations
	Activity/Achievement	# of Years	Remarks	Item weight

more items

SCHOLASTIC RECORD

Official School Transcript (must be signed by a school official)

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

Since grade point scales vary by district, please provide a brief explanation of your school’s grade point scale (e.g.“out of a possible 4.0”) or include a copy and /or description of the scale with the transcript.

Cumulative Grade Point Average

(2.0 or above)

This GPA is based on a:

4.0 scale

5.0 scale

Blended grading scale

ACT Composite (if applicable)

SAT Composite (if applicable)

Attachments:

One teacher recommendation (no longer than 500 words)

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

One recent photo of the applicant

One file only.
100 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 and Ohio’s Electric Cooperatives, Inc. may disclose any or all of the information contained in this application and the supporting documents and letters of recommendation and nomination, or otherwise provided in connection with this application, to the judges of the scholarship competition and to any employees of the Cooperative or of Ohio’s Electric Cooperatives, Inc.

Date

Applicant's Signature

Sign above

Parent / Guardian's Signature

Sign above