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Interview Entry Form

Deadline: November 13, 2009

Youth Tour Requirements:

Must be able to participate in the Youth Tour trip to Washington, D.C. on June 10-18, 2010.
Must be able to ride in a car or bus for up to 12 hours (with breaks) in a single day.
Must be able to fly in an airplane.
Must be able to (and agree to) reasonably assist South Plains Electric Cooperative in presentations promoting the Youth Tour program and the Cooperative, including a presentation at the local membership meeting.
The Cooperative reserves the right to select the runner up or another contestant for the Youth Tour trip if the recipient is found to be a poor representative of the Youth Tour program and the Cooperative.
The winner’s parents/guardians must give the Cooperative written permission and a waiver of release for the recipient to participate on the Youth Tour.
The recipient will be covered by the Youth Tour’s insurance from home and back.

Youth Information

All fields are required unless marked optional.

First Name
Last Name
Date of Birth (ex: 05-20-1982)
Age (ex: 18)
Address 1
Address 2 optional
City
State (Ex: TX)
Zip Code
Phone Number
Cell Phone Number optional
E-mail
Parents/Guardians:

School Information

All fields are required unless marked optional.

If applicable, teacher/counselor who encouraged your participation in this contest: optional
Are you currently a high school junior or senior?
High School Name
How did you hear about this scholarship?

Contestant's Statement

All fields are required unless marked optional.

I have read the Youth Tour Contest Eligibility Rules and Requirements. By signing below, I attest that I fully understand all of the rules and requirements of this contest and what will be required of me in the event I should be selected.

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