Name *

First

Last

Program Opportunities (Select at least one, or more than one if interested)

Junior MAC Member

Youth Tour

Cooperative Leadership Camp

Street Address *

City *

State *

Zip Code *

Phone (Mobile)

Phone (Home)

Email *

Date of Birth *

Parent or Guardian Name *

First

Last

Phone *

Email *

High School *

Principal Name *

First

Last

Principal Email Address *

Grade *

Academic Honors *

How did you hear about this program? *

Student Resume *

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Essay Topic: EnergyUnited is dedicated to building a brighter energy future for its members by supporting beneficial electrification initiatives and by continuing to increase its utilization of renewable energy resources. When you think of a brighter energy future for your community, what do you envision? How can electric cooperatives like EnergyUnited support your vision? *

School Transcript or Letter from School Counselor Confirming Transcript Request *

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