ABOUT US
OVERVIEW
COMMUNITY
Sponsorships
Scholarships
Free Stuff
PUBLICATIONS
FINANCIALS
CAREERS
LOCAL MIDATLANTIC BRANCH Select one.... BelAir Chestertown Denton Dover EastNewMarket Frederick Georgetown Hagerstown Lancaster Martinsburg Pocomoke Quarryville Salisbury Shoemakersville Westminster Winchester Woodstock
TODAYS DATE
SOCIAL SECURITY NUMBER
DATE OF BIRTH Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
LAST NAME
FIRST NAME
MIDDLE INITIAL
HOME ADDRESS
CITY
COUNTY OF RESIDENCE
HOME TELEPHONE
PARENT(S) OR GUARDIAN(S) NAME
ADDRESS
STATE Choose DE MD PA VA
ZIP
NAME AND LOCATION OF HIGH SCHOOL(S) ATTENDED
CURRENT YEAR IN SCHOOL Choose One... High School Senior College Freshman College Sophomore College Junior
CURRENT GRADE POINT AVERAGE
NAME AND ADDRESS OF TWO- OR FOUR-YEAR COLLEGE OR TECHNICAL SCHOOL YOU PLAN TO ATTEND
HAVE YOU BEEN ACCEPTED? Accepted Not Accepted
LEADERSHIP EXPERIENCE
List any School and Community Activities
List any Awards or other Forms of Recognition You Have Received (academic, sports, community)
List Past Employers and Type of Work
ESSAYS
What is your field of study, and how did you choose it?
What do you hope to do with your education?
Why and how do you think cooperatives are beneficial to the future of agriculture?
By submitting this application I hereby state that the information submitted is true and correct to the best of my knowledge. I grant permission to use all or part of the essays, as well as any photographs which may be taken for The Leader or for any publicity or advertising purposes.
PERSONAL INFORMATION
