PEOPLES TELEPHONE COOPERATIVE, INC.
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1 PEOPLES TELEPHONE COOPERATIVE, INC. EDUCATION SCHOLARSHIP FUND Peoples is proud to once again be awarding fifteen (15) $1,000 scholarships to graduating High School Seniors throughout our service area whose parents or legal guardians are active members of Peoples Telephone Cooperative, Inc. (An active member is defined as a subscriber receiving local landline service/dial tone within a Peoples Telephone exchange as of January 1 of the year of application.) High School seniors and non-traditional graduating students are encouraged to apply. (Non-traditional students include those students attending private, parochial or home school.) Disbursement of Scholarship Scholarship winners will be announced at the awards presentation or graduation ceremony of the recipients schools. Award recipients must present Peoples with proof of acceptance and registration for the upcoming term at their accredited college, university, or vocational school before funds will be disbursed. Peoples will then submit payment to the selected institution on behalf of the student. Additional criteria are found on the scholarship application form. The scholarship application form, along with all required materials, must be received or postmarked, to the following address no later than March 29, 2018: Peoples Telephone Cooperative, Inc. Attn: Marketing Department P O Box 228 Quitman, TX Incomplete and/or applications received after the deadline will not be considered. Questions regarding this scholarship may be directed to: Marketing at
2 PEOPLES TELEPHONE COOPERATIVE, INC. SCHOLARSHIP Application Deadline: March 29, 2018 Scholarship Eligibility & Criteria Applicant must be a graduating high school senior who plans to attend an accredited institution of higher education in the Fall. Applicant s parent or legal guardian must be an active member of Peoples Telephone Cooperative, Inc. (Employees, Directors, and their dependents are not eligible.) Scholarship winners must be accepted and registered as a full time student (min 12 credit hours) for the upcoming Fall term at an accredited college, university or vocational school before funds will be disbursed. Applicant must submit a completed scholarship application by the deadline including all requested forms. Applicant must provide a recent, professional photo (no selfies please), with application. This photo is to be used for publication in our magazine, on social media and other publications in the event they are selected as a scholarship recipient. Scholarship information and applications will be available from the Peoples Telephone Cooperative Office in Quitman or online at Applications may be requested beginning January 1 st of each year. APPLICATION CHECKLIST: Completed Application Form Current Photo Reference Letter from High School Teacher/Official Reference Letter from Community Member (not related to applicant) School Certification Form Student Signature Page/Release Form Essay All requested supporting documentation/materials must be included for the application to be complete. Incomplete and/or applications received or postmarked after March 29, 2018 will not be considered. 2
3 Peoples Telephone Cooperative, Inc. Education Scholarship Fund SCHOLARSHIP APPLICATION Application Deadline: March 29, 2018 Name: Contact # Address: City, TX Zip Father s Name: Employed by: If self-employed, Name of Company: Mother s Name: Employed by: If self-employed, Name of Company: To apply you or your parent/guardian must me an active member of Peoples Telephone Cooperative. An active member is defined as a subscriber receiving local landline service/dial tone within a Peoples Telephone exchange as of January 1 of the year of application. Member s Name (as shown on billing stmt): Peoples Telephone Number: High School Currently Attending: Number of dependent children in family (including applicant): How many other family members are currently in college? University or College you plan to attend: Field or vocation you plan to study: Have you applied for admission? Yes No Estimated college expenses for one (1) year: Have you been awarded any other scholarships to date? If so, for what amount? 3
4 Awards and Honors List all academic awards and honors received in high school: Year Award/Honor High School Clubs/Activities List the activities in which you have been involved and the number of years you have participated in each: # of Yrs Activity (Attach additional page if needed.) 4
5 Community Clubs/Activities List all non-paid/volunteer activities in which you have participated in the last 4 years (For example: volunteer efforts, civic organizations and church work): # of Yrs Activity TELL US A LITTLE ABOUT YOURSELF Favorite Hobbies or Recreational Activities: Favorite Quote: Achievement you are most proud of at this point in your life: 5
6 SCHOOL CERTIFICATION The following must be provided and certified by a School official. Failure to provide this information will disqualify this application. APPLICANT S NAME: Cumulative GPA (9 th through 12 th grades) on scale of 4.0. Class Standing: # in a class of students. ACT Score SAT Score Printed Name of School Official Certifying Grades, Scores & Standing Title Signature of School Official Certifying Grades, Scores & Standing 6
7 In approximately 100 words, write the following in your own handwriting. Describe the community in which you live and indicate how it has influenced the person you are today. 7
8 I hereby certify that all of the information provided in this application is complete and true to the best of my knowledge. I hereby grant permission to Peoples Telephone Cooperative, Inc. to contact my school if necessary for the review of this application and my school records. I also grant permission to Peoples to use my name and likeness in promotional materials in the event that I am selected to receive a scholarship award. In applying for this scholarship, I am aware that I am expected to maintain above average grades (at least 2.5 on a 4.0 scale) and demonstrate acceptable standards of citizenship and character. Signature of Applicant Signature of Parent/Guardian who is a Member of Peoples Telephone Cooperative, Inc. ******************************************************************************************** APPLICATION WILL BE DISQUALIFIED IF THIS PAGE IS INCOMPLETE. ******************************************************************************************** 8
9 LETTER OF RECOMMENDATION - SCHOOL OFFICIAL INSTRUCTIONS: APPLICANT: sign the Letter of Recommendation where indicated before presenting this from to the individual writing your recommendation. COMPLETER: The letter of recommendation must be completed on the provided form and placed in an ENVELOPE and SEALED. Please sign the completed form and return the sealed envelope to the student. APPLICANT NAME: In accordance with the Family Educational Rights and Privacy Act of 1974, I waive my right to review this recommendation by signing my name below. This recommendation will be held in confidence by Administrators of the Peoples Telephone Cooperative, Inc. Scholarship Fund for use in scholarship selection only. Applicant s Signature Printed Name The following is to be completed by the individual submitting the referral: I,, have known the person listed above (Please print name) for years. Manner in which you know the applicant: (For example: you are their coach, teacher, family friend, etc.) 9
10 Letter of Recommendation pg 2 What would you describe as the applicant s greatest strength and how have you seen it displayed to make a positive impact in his/her life or with others? Provide an example that demonstrates the applicant s level of perseverance. Personal Comments: Signature Please return this form to the student in a sealed envelope. Thank You for taking time to recommend this student for consideration! 10
11 LETTER OF RECOMMENDATION COMMUNITY MEMBER INSTRUCTIONS: APPLICANT: sign the Letter of Recommendation where indicated before presenting this from to the individual writing your recommendation. COMPLETER: The letter of recommendation must be completed on the provided form and placed in an ENVELOPE and SEALED. Please sign the completed form and return the sealed envelope to the student. APPLICANT NAME: In accordance with the Family Educational Rights and Privacy Act of 1974, I waive my right to review this recommendation by signing my name below. This recommendation will be held in confidence by Administrators of the Peoples Telephone Cooperative, Inc. Scholarship Fund for use in scholarship selection only. Applicant s Signature Printed Name The following is to be completed by the individual submitting the referral: I,, have known the person listed above (Please print name) for years. Manner in which you know the applicant: (For example: you are their coach, teacher, family friend, etc.) 11
12 Letter of Recommendation pg 2 What would you describe as the applicant s greatest strength and how have you seen it displayed to make a positive impact in his/her life or with others? Provide an example that demonstrates the applicant s level of perseverance. Personal Comments: Signature Please return this form to the student in a sealed envelope. Thank You for taking time to recommend this student for consideration! 12
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