NATIONAL RURAL ELECTRIC COOPERATIVE ASSOCIATION (NRECA)
YOUTH LEADERSHIP COUNCIL—APPLICATION FORM
TEXAS

 

Must submit by March 18, 2011.

 

Please do not complete this application if you will be unable to attend the YLC Conference in Washington, D.C., July 16-20, 2011, and the NRECA Annual Meeting, March 3-6, 2012, San Diego, CA.
_________________________________

Dates for Youth Leadership Conference in Washington, D.C., are July 16-20, 2011. 

 

Dates for 2012 NRECA Annual Meeting in San Diego, CA, are March 3-6, 2012.
--------------------------------------
First Name:  
Middle Name:
Last Name:  
Phone:  
Cell Phone:  
Email Address:  
Age:    
Date Of Birth:
   
Address:  
City:  
State:  
Zip:    
Parent(s) Name: Father:  
Mother:
   
Shirt Size:
   
City & Airport Closest to Your Home:
Approximate Driving Time to Airport:
Local Newspaper Name:
Local Newspaper Address:
   
Sponsoring Cooperative Name:  
Address:  
City:  
State:  
Zip:    
Phone Number:  
Sponsoring Cooperative Contact:  
Statewide Contact:
   
   
SCHOOL RELATED
School Name:
School Address:
School Phone Number:  
School Fax Number:  
Principal Name:
Grade Enrolled:
Scholastic Standing Last Year:
Major Study Interest:
Career Goal:
   
Please list activities you have participated in and any special honors you have received during your high school attendance, such as class officer, plays, music, athletics, etc.
ACTIVITY
YEAR(s)
REMARKS
EXTRA CURRICULAR ACTIVITIES
List extracurricular activities and years of involvement in which you have participated, such as 4-H, FH, FFA, church, community, service clubs, etc.
ACTIVITY
YEAR(s)
REMARKS

 

 


 

**NOTE** If you press the submit button and nothing happens check your entries for errors