NameThis field is for validation purposes and should be left unchanged.Name(Required) First Last Age(Required)Date of Birth (MM/DD/YYYY)(Required) Month Day Year Phone Number(Required)Email Address(Required) Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Parents/Guardian Name(Required)CCEC Account Number(Required)High School Name(Required)Current Grade(Required)Career Goals(Required)School/Extracurricular Activities(Required)List scholastic activities that you have participated in for school or in your community, any special awards or honors you have received or offices you have held. Be sure to include dates of participation.Hobbies & Special Interest(Required)Choose 1 of the following 2 activities to complete: Letter: Write a letter to an elected official about an important issue you are interested in and attach it to this application. This letter should be no more than 1 page in length. You may choose to write in favor of or against this issue. The topic for the letter may be of local, state or national interest. And depending on the topic, the letter should be addressed to your representative on your county board of commissioners, to Raleigh to your General Assembly members or to Washington, D.C. to your members of Congress. or Video: Create a video of no more than 90 seconds. Use this video to introduce yourself. The video should be creative, fun, and interactive. It should accomplish the following: Introduce yourself, describe any community or school activities you are involved in, let us know what hobbies, talents and special interests you may have, tells us what your future plans are, and let us know how the National Rural Electric Cooperative Youth Tour will benefit your future ambitions.Upload LetterMax. file size: 900 MB. orVideo Link URLTo submit the video, upload to YouTube and include your link here. Applicant Consent(Required) I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Applicant Signature (Full Name)(Required)Email a copy of this form for your recordsEnter the email you'd like a copy of this form sent to. (optional) Questions concerning the National Rural Electric Cooperative Youth Tour should be addressed to: Melissa Glenn Communications Director Email Melissa
