Scholarship Applica on

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West River Telecom SCHOLARSHIPS ELIGIIBILITY HOW TO APPLY 2019 Scholarship Applica on Eight $1,000 scholarships and one $1000 technical scholarship are available. General scholarships will be awarded based on up to one scholarship per district for each of WRT s seven districts. (WRT District Map a ached) The child of a WRT employee or director may be eligible for a separate scholarship. The technical scholarship may be awarded to a student pursuing a degree/career that is technology-based such as telecommunica- ons, electronics and computer technology, network systems administra on, network and communica ons management, informa on technology, and web development. WRT scholarships are available to a gradua ng high school senior or student in college or another postsecondary ins tu on--one TIME ONLY. Only current members of WRT and/or their dependents are eligible to receive this scholarship. Scholarship applica ons along with WRT District maps will be mailed to all area schools. Applica ons are also available on WRT s web site (www.westriv.com). Please complete applica on by wri ng legibly in ink or typing. If more space is needed please con nue on a separate sheet of paper. WRT Scholarship Applica ons must include the following items: 1. Completed Applica on Forms 2. Copy of High School (&/or Postsecondary/College) Transcript 3. Copy of ACT Composite Score DEADLINE Applica ons must be returned to WRT by one of the op ons below: - Deliver to: WRT s Hazen office &/or drop box by 5:00pm on March 1, 2019 - Mail to: WRT Scholarships, PO Box 467, Hazen, ND 58545 (postmarked by 3-1-2019) - Email to: WRT@westriv.com QUESTIONS Any inquiries regarding the scholarship program should be directed to: Lisa Ro, WRT Member Services at the WRT Hazen Office email: lisar@wrtc.com phone: (701) 748-2211 NOTE The scholarship award will be mailed to the student upon successful comple on of the first semester/quarter and proof of enrollment in the second semester/quarter. email: WRT@westriv.com phone: 701.748.2211 fax: 701.748.6800 web: www.westriv.com social: www.facebook.com/mywrt mail: PO Box 467 (101 Main St W), Hazen, ND 58545 Offices: Hazen & Beulah, ND Mobridge, SD

2019 Service Area District Map North Dakota South Dakota

Name: Applicant s Phone #: Last First Form2019 Scholarship Applica on Home Address: Address City State Zip Name of Parent(s) or Legal Guardian: Parent(s) Phone #: Address, if different from yours: Name of High School: Address City State Zip High School Gradua on Date: Postsecondary/College you a end/plan to a end: Loca on: Intended Major: WRT District Number: Applicant s Email/Cell Phone# : The WRT District Map is also located in your WRT Phone Book & online at www.westriv.com Up to one scholarship may be awarded per district for each of WRT s seven districts. I cer fy that the informa on provided is complete and accurate to the best of my knowledge. I agree that if I am offered and accept an award from WRT, WRT may use my name, the name of my parent(s) or legal guardian, the name of my community, the name of my high school, the amount of the award, and the name of the postsecondary/college I plan to a end in press releases, public announcements, or other promo onal materials. I understand my applica on will be considered in confidence. Student Signature Date Parent s Signature (If student is under 18 years old) Date The WRT Scholarship is available to a gradua ng high school senior or student in a postsecondary ins tu on or college. To be eligible, you, your parents or legal guardian must be members of and receiving telephone service from WRT. YOUR APPLICATION MUST INCLUDE: 1. Completed Applica on Forms, 2. A copy of your high school or college transcript, and 3. A copy of your ACT composite score. Applica ons must be returned by March 1, 2019 via: delivery to a WRT office by 5:00pm March 1, 2019; email to WRT@westriv.com; or mailed to WRT, A en on Scholarships, PO Box 467, Hazen ND 58545 - postmarked no later than March 1, 2019.

School Community Experience School & Community List all school and community ac vi es in which you have par cipated in the last four years. Ac vity Number of Years Par cipated Offices Held Honors/Special Awards Work Experience Describe your work experience during the past four years and indicate if it was during the summer or a er school, as well the months/years worked. May include part- me employment, farm work, babysi ng, etc. Posi on Summer Job(s) During the School Year Months/Years Worked

Plans Goals Circumstances 2019 Future Plans & Goals Please include the following: 1) where you plan to con nue your educa on, 2) your major/degree, 3) career aspira ons and 4) any addi onal future plans/goals. Unusual Circumstances* (*op onal) Please include any personal challenges you have faced that may have limited your par cipa on in school/community ac vi es and/or affected your achievements in school, work experience, etc.