WIN Energy REMC Scholarship Program
As a cooperative, we are committed to the community we serve and want to
show our commitment by financially supporting our local young people in their
pursuit of higher education. A scholarship program has been established for
graduating seniors that meet the qualifications listed below. Applications must be
submitted to the WIN Energy REMC office no later than 4:30 p.m. local time on
February 17, 2017. Applications can be downloaded from our website and
completed electronically. Recipients will be recognized and awarded certificates
at the WIN Energy REMC Annual Meeting April 1, 2017. Scholarship funds will be
disbursed to the student upon proof of enrollment.
QUALIFICATIONS:
• The parents/legal guardians of the applicant must be WIN Energy REMC
members.
• Applicant must be a 2017 graduating senior and have maintained a
cumulative grade point average of a C or higher. A copy of the high school
transcript is required.
• Scholarship funds may be applied toward tuition or course fees at any
recognized two-year or four-year college or trade school.
• Recipients must be enrolled as a full time student in the fall of 2017. Proof
of enrollment must be presented to WIN Energy REMC.
• Full or part-time employees of WIN Energy REMC; or a spouse, son,
daughter, stepson, stepdaughter, grandchild, brother, sister, aunt, uncle,
niece or nephew of an employee or director of WIN Energy REMC are
ineligible to apply.
Application #____________
2017 WIN Energy REMC Scholarship Application
Please submit completed application and current transcript. Deadline for submission is February 17, 2017.
Application information must be confined to the official application form with no attachments other than grade
transcripts. Please return all five pages of the application, incomplete applications will not be considered.
**Applications can be downloaded from winenergyremc.com**
PERSONAL INFORMATION
Applicant Name: ______________________ ___________________ ___________________________
(First)
(Middle)
(Last)
Mailing Address: ______________________________________________________________________
City: _____________________________________ State: __________________ Zip: ______________
Student Cell Phone: (____) ___________________ Home/Parent Phone: (____) ___________________
Can we send text messages?
□Yes □ No
Student Email Address: ___________________________
Parent(s)/Guardian(s) Name: ____________________________________________________________
WIN Energy REMC Account Number: ______________________________________________________
Are you related to any employee or board director of WIN Energy REMC? Yes or No (circle one)
If yes, please list employee/director name and relationship_____________________________________
***spouses, children, grandchildren, siblings, aunts, uncles, nieces & nephews of an employee or board director are ineligible to apply***
_____________________________________________________________________________________
STATEMENT OF APPLICANT AND PARENT/GUARDIAN
We have examined this application and the records are true, complete and accurate. We do hereby
grant permission for the release of the required scholastic records.
Date: _________________________
Signed: _____________________________________________
(Applicant signature)
Signed: _____________________________________________
(Parent/Guardian signature)
Please submit scholarship application form with a copy of the applicant’s high school transcript to:
WIN Energy REMC
Attn: Scholarship Program
3981 S US Highway 41
Vincennes, IN 47591
Page 1 of 5
Application #____________
ACADEMIC INFORMATION
Name of High School: __________________________________________________________________
High School Mailing Address: ____________________________________________________________
City: ___________________________________ State: ______________________ Zip: _____________
High School Phone Number: (____) __________________ Contact Name: _________________________
Date of Graduation: _________________________ Cumulative Grade Point Average: ______________
ACT composite scores: English: ________ Math: ________ Reading: ________ Science: ________
PSAT/SAT scores:
Writing: ____________ Math: ____________ Critical Reading: ___________
***Please attach a copy of applicant’s high school transcript***
Colleges or Trade Schools applied to: ______________________________________________________
_____________________________________________________________________________________
Intended major(s): _____________________________________________________________________
ACTIVITIES AND INTERESTS
Community Activities-list activities participated in the community including volunteer, interests, hobbies, etc.
Year(s) Participated
Organization
Hours Worked Per Year
1. ______________________________________________________________________________
Description:____________________________________________________________________
______________________________________________________________________________
2. ______________________________________________________________________________
Description:____________________________________________________________________
______________________________________________________________________________
3. ______________________________________________________________________________
Description:____________________________________________________________________
______________________________________________________________________________
Page 2 of 5
Application #____________
School Activities- list activities participated in during high school including class officer, school clubs,
athletics, etc. LIST EACH ACTIVITY ONCE
Grade Level(s) Participated
Activity
Honors and Awards
1.___________________________________________________________________________________
_____________________________________________________________________________________
Description:___________________________________________________________________________
_____________________________________________________________________________________
2.___________________________________________________________________________________
_____________________________________________________________________________________
Description:___________________________________________________________________________
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3. ___________________________________________________________________________________
_____________________________________________________________________________________
Description:___________________________________________________________________________
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4.___________________________________________________________________________________
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Description:___________________________________________________________________________
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5.___________________________________________________________________________________
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Description:___________________________________________________________________________
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6.___________________________________________________________________________________
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Description:___________________________________________________________________________
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7.___________________________________________________________________________________
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Description:___________________________________________________________________________
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Application #____________
8.___________________________________________________________________________________
_____________________________________________________________________________________
Description:___________________________________________________________________________
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9.___________________________________________________________________________________
_____________________________________________________________________________________
Description:___________________________________________________________________________
_____________________________________________________________________________________
WORK EXPERIENCE
Dates
Employer
Position/Duties
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
PERSONAL STATEMENT
Answers must be submitted in full sentence form and must not exceed 100 words.
What do you hope to accomplish in college and how will that help you be successful in the future?
_____________________________________________________________________________________
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Application #____________
SHORT ANSWER
Answers must be submitted in full sentence form and must not exceed 150 words.
Please explain how you demonstrate leadership and community involvement through your activities,
interests, and work experience.
_____________________________________________________________________________________
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Please demonstrate your understanding of the principles that electric cooperatives are founded on.
_____________________________________________________________________________________
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