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Send the following items to the Pioneer Electric Cooperative, Inc. Scholarship Committee. The information must be received by February 6, 2012.

This completed original application.
A resume stating your future plans, activities you have participated in while in school, accomplishments and honors you have received and your employment experience.
An official certified high school transcript.Mail official HS transcript to:

Pioneer Electric Scholarship Program
c/o Kris Leisher
PO Box 368
Ulysses, KS 67880
A paragraph explaining why you would be a good recipient for a Pioneer Electric scholarship.

Selection will be made without regard to the applicant’s race, color, ethnic origin, religious belief, gender, marital status or physical handicap.

Applicant's Name:*

Permanent Address:*

City:*

Zip:*

Phone No.:*

Parent/Guardian name(s):*

High School:*

High School GPA:*

Email Address:*

Name and address of higher institution you plan to attend:

Name:*

Address:*

City:*

State:*

Zip:*

Major field of study (if known):

Upload a copy of your Resume*
(valid extension(s): .doc, .pdf, .txt, .rtf; max file size 2000 Kb)

Explain why you would be a good recipient for a Pioneer Electric scholarship*

disclaimer

I understand that checking this box constitutes my digital signature of this form.*

PIONEER ELECTRIC COOPERATIVE
1850 West Oklahoma
Ulysses, Kansas 67880
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YOUR TOUCHSTONE ENERGY COOPERATIVE