P e a c e R i v e r E l ec t r i c C o o p e r a t i v e/ O p e r a t i o n R o u n d U p 2 0 1 5 Sc h o l a r s hi p A p pl i c a t i o n Purpose: Operation Round Up Charitable Foundation was formed by Peace River Electric Cooperative (PRECO) for the purpose of granting charitable funds to the communities we serve. Selection Criteria: Scholastic achievement, character, leadership, service, work experience, career and life goals, and any other pertinent information/circumstances are considered. Consideration is not based solely on need, nor is it a predominate basis. Eligibility: Only PRECO members and their dependent children (including legal guardianship) may apply. Student’s permanent legal address must be a home served by PRECO. Applicant must have a minimum 2.75 unweighted or 3.25 weighted grade point average (GPA). Requirements: Recipients are subject to conditions of enrollment, usage of funds, grades requirements and other criteria, including good moral character. Acceptance of scholarship funds constitutes acceptance of these terms. 1) Answer each question honestly and completely; 2) Include high school transcript; 3) Provide at least one: a) ACT — minimum score: 25, b) SAT — minimum score: 1130, c) PERT — minimum scores: Reading: 106/Math: 114/Writing: 103; 4) Enclose a full one-page essay, typed and double-spaced: Describe your educational, career and life goals, why you have chosen this path, and how you will give back to the community; 5) Enclose three (3) letters of recommendation from adult, non-family members (employer, teacher, religious leader, mentor, club sponsor, coach, etc.); 6) Include “Educator Recommendation Form” (page 5); 7) Include entire FAFSA form or most recent IRS income tax filing; 8) Deadline: Application and attachments must be postmarked no later than February 28, 2015. ORU Scholarship Application 2015 Page 1 of 6 Limitations: Scholarship recipients are subject to certain terms and conditions. 1) Scholarship funds must be claimed in consecutive years, beginning in the academic year the scholarship was awarded. Applicant must prove eligibility. Funds cannot be deferred without express permission from the Foundation’s Board of Directors; 2) Scholarship is available to graduating high school students, students already attending college, and adults with a high school equivalent; 3) Scholarships are awarded in the Spring, but are contingent on the recipient graduating high school and passing required graduation exam(s); 4) Scholarship funds are paid directly to the educational institution for credit to the student’s account. Unused funds must be returned to the Operation Round Up Charitable Foundation; 5) Student must attend accredited two-year or four-year institution, community college, technical school, vocational school, or continuing education institution; 6) Student must attend the institution on a fulltime basis. Failure to qualify as fulltime will result in rescission of funds. Annually, before scholarship funds will be released, student must request written verification of eligibility from their educational institution. 7) Any scholarship winner who learns that he or she will receive a full scholarship from another source must notify PRECO and relinquish all claims to the Operation Round Up scholarship. Instructions: 1) Incomplete or late applications will be disqualified; 2) Do not staple the application or insert in a binder. Paperclip only; 3) Applicants must use this application form. If additional space is needed, attachments are acceptable. 4) Application must be typed. The application is available in fill-in-the-blank PDF format at www.preco.coop. ORU Scholarship Application 2015 Page 2 of 6 Scholarship Application 2015 Two-Year/Four-Year Accredited Institution Late or incomplete applications will be disqualified. Student must reside in a residence served by PRECO. Pages 3 and 4 of Application must be typed Applicant____________________________________________________________________________ Last name First Middle Initial Parent/Guardian______________________________________________________________________ Last name First Middle Initial _____________________________________________________________________________________ Physical Address Mailing Address _____________________________________________________________________________________ City County ___________________________________________________ State ______________________________ Telephone Number Peace River Electric Co-op Member # _________________________________________________________ _________________________ Email Address Are you a US Citizen? Zip Code Social Security # If not, how long have you lived in the US? High School Information Name of your high school________________________________________________________________ GPA________ Check if weighted Scores: ACT : High School Graduation Date ___________________________ SAT: PERT: Reading Math Writing Colleges Applied Information College Name Address City State Accepted? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ORU Scholarship Application 2015 Page 3 of 6 (For the questions below: additional sheets are acceptable, if more space is needed) All Scholarships or Grants – Applied for or Received Name of Scholarship Amount Renewable-Y/N? Years _____________________________________ _____________ ___________ ___________________ _____________________________________ _____________ ___________ ___________________ _____________________________________ _____________ ___________ ___________________ _____________________________________ _____________ ___________ ___________________ Community & Extracurricular Activities, Clubs, Organizations and Volunteer Service Activities in Priority Order Dates ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Honors & Awards Hours/Week _________________________________ _________________________________ _________________________________ _________________________________ _________________________________ Honor/Award Name Year Received _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ Employment Information Applicant: Employer _______________ _______________ _______________ _______________ _______________ Address City ______________ ______________ ______________ ______________ ______________ ______________ State Zip Code Hours/Week _________________________________________________________________________ ___________ _________________________________________________________________________ ___________ Employment: All other members of the household Employer Name City State Zip Code _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ Other members living in the household Last Name First MI Relationship _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _________________________________________________ ____________________________ Hours/Week ___________ ___________ ___________ ___________ Attending College? Y or N__________ Y or N__________ Y or N__________ Y or N__________ List any other special financial considerations___________________________________________________________________ ________________________________________________________________________________________________________ The information contained in this statement is for the purpose of obtaining funding from Peace River Electric Cooperative’s Operation Round Up Charitable Foundation (ORU), on behalf of the undersigned. Each undersigned understands that the information provided herein is used in grant funding decisions, and represents and warrants that the information provided is true and complete, and that ORU may consider this statement as continuing to be true and correct until a written notice of a change is provided. ORU is authorized to make all reasonable inquiries deemed necessary to verify the accuracy of the statements made herein. I hereby grant consent for Peace River Electric Cooperative to publish the applicant’s name and pertinent information in newspaper, magazine and other publication types. ________________________________ Applicant Signature ________________________________ Parent/Guardian Signature Application and all supporting documents must be postmarked by February 28, 2015 Mail to: Operation Round Up Scholarship Committee Peace River Electric Cooperative, Inc., PO Box 1310, Wauchula, FL 33873-1310 ORU Scholarship Application 2015 Page 4 of 6 2015 EDUCATOR RECOMMENDATION FORM Applicant Name________________________________________________________________ Last First MI School________________________________________________________________________ High School City State Zip Code To be completed by Educator or Guidance Councilor How well, how long, and in what capacity do you know the applicant:____________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Do you believe this student will continue his/her education until completion?______________________ _____________________________________________________________________________________ _____________________________________________________________________________________ In comparison to other students whom you have known at comparable stages of development, how would you rate the applicant in the following areas? If unable to evaluate, leave blank. Please circle one per line: Below Avg Avg. Above Avg. Excellent Seriousness of Purpose 1 2 3 4 Initiative 1 2 3 4 Maturity 1 2 3 4 Adaptability 1 2 3 4 Enthusiasm 1 2 3 4 Emotional Stability 1 2 3 4 Leadership 1 2 3 4 Public Speaking __ 1 2 3 4 List an example of how the student has demonstrated one of the qualities shown above. List any additional comments which you believe describes this student. _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Signature Title or Position Date Return this form to student in a sealed envelope. ORU Scholarship Application 2015 Page 5 of 6 Guidance Office Checklist (Student: Give this form to your Guidance Counselor) Student Name:_________________________________________________________________ Guidance Office: Please complete and sign Confirm: Yes or No: (If “no,” return to student. Incomplete applications will not be considered for scholarship funds) ______ 1) Sealed transcript enclosed ______ 2) Cumulative high school GPA is shown on application ______ 3) ACT, SAT, and/or PERT scores are listed on application ______ 4) FAFSA Report OR latest IRS filing enclosed ______ 5) Student essay is a full page, typed and double-spaced, describing student’s educational, career and life goals ______ 6) Educator Recommendation Form and three (3) letters of recommendation enclosed ______ 7) Pages 3 and 4 of the Scholarship Application must be typed. For convenience, an online fill-inthe-blank PDF application is available at www.preco.coop. _____________________________________________________________________________________ Guidance Counselor’s Signature Date Application and all supporting documents must be postmarked by February 28, 2015 Enclose with application and mail to: Operation Round Up Scholarship Committee Peace River Electric Cooperative, Inc., PO Box 1310, Wauchula, FL 33873-1310 ORU Scholarship Application 2015 Page 6 of 6
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