GreyStone Power Corporation

GEMC Walter Harrison 2014 Scholarship Application

Deadline for application is Jan. 31, 2014.

*Name:

*Address:

*City:

*State:

*Zip:

E-Mail:

*Phone Number:

Last 4-digits of SSN:

*Applicant's electric cooperative:

Parental information is not required of adult, non-dependent applicants.

If adult applicant is married, spouse’s information must be included.

Adult Applicant Information

*Applicant's Place of Employment:
*Phone Number:

Parent Information

Home Address:
Home Phone:
Parents' Names:
Father's Place of Employment:
Phone Number:
Mother's Place of Employment:
Phone Number:

Spouse Information

Spouse's Place of Employment:
Phone Number:

Academic Performance and Potential

*High School or college grade average:	(4.0 point scale)
*SAT or ACT score:

Below, describe participation in extracurricular activities. If necessary, provide additional information. (See instructions below for providing additional documentation.)

Membership in organizations:

Offices held in organizations:

Honors and recognitions received:

Other Activities:

College or technical school which you plan to attend or currently attend:

*School name:
*Contact person:
*Mailing address:
*Phone number:
*Date you will begin attending:	(MM/DD/YYYY)
OR
Status in College:
*Tuition per quarter/semester $:

Financial Need Assessment(Will be handled as strictly confidential information)

Total adjusted gross income for household (From most recent income tax return)
*Adjusted Gross Income $:
*Other household income $:
Number of family members residing in household
*Number of family members:

Other factors which influence financial need:

Proof of financial information submitted may be required if scholarship is awarded.

Please provide the following: (See instructions below for submitting additional documentation.)

A. Acceptance letter or other evidence to confirm admission to a Georgia college or technical school. If student is not yet accepted, this information will be required at the time the scholarship is awarded.

B. Two-page autobiographical sketch with reference to future plans and goals and your involvement in the community. Do not reveal your name, the name of your cooperative or your place of residence in the bio, as any such reference will be marked out before being submitted to the judges, which will not make for an attractive, readable document.

C. High school transcript or current college/technical school transcript (unless student graduated more than 10 years ago).

D. S.A.T. or A.C.T. score. You must not whether the SAT score is from a two-or three-part test.

E. Two letters of recommendation.

I certify that all information reported on this application is true and correct to the best of my knowledge.

Your Signature

Date (MM/DD/YYYY)

Scholarship Requirements

1. The recipient’s primary residence must be the household of an EMC member or EMC employee. All EMC members and employees are also eligible.

2. The recipient must be enrolled in an accredited program, either full-time or part-time.

3. The recipient must be an undergraduate student only.

4. The scholarship fund will be in the form of a grant program with funds being paid to the college,university, or vocational school.

5. A person may submit an application each year, but previous winners are not eligible for a second scholarship.

6. The scholarship fund will provide $1,000 for each scholarship winner’s educational expenses. The number of scholarships will depend on the fund earnings.

7. Scholarship use must commence within one year of date of issuance and be totally utilized within two years of the date of issuance. The school shall return any unused funds to the scholarship fund.

8. The scholarship may be used at any two-year or four-year accredited college or university in Georgia including vo-tech schools.

9. A combination of need and academic ability will be used in determining scholarship fund winners.

10. Each EMC may submit one application for each $1,000 that they have contributed to the fund to the executive committee for consideration in choosing the scholarship fund winners.

11. An executive committee will oversee the scholarship fund. This committee will consist of the Chairman of the Board of GEMC, the Vice-Chairman of the Board of GEMC, the Chairman of the Services Committee, the Manager of Planters EMC, the Manager of Excelsior EMC, and the Chief Executive Officer of GEMC (ex officio member).

12. Georgia Southern University will administer the scholarship fund.

13. Scholarship winners must notify their EMC Walter Harrison Scholarship Coordinator of their acceptance of the award and the name of the school they plan to attend by June 1st or they will forfeit the scholarship.

Instructions for submitting additional documents:

There are five methods available for submitting additional documentation. Method 1: Electronic File Upload You can upload an image or PDF using the file upload tool, below. The file can be up to 10 MB in size and must be one of the following file types: PDF JPG JPEG PNG GIF ZIP. If you have multiple files, you can combine them into one zip file (using your zip software) and attach the zip file to this application with the file upload tool.
Attach Document:
Method 2: Fax Fax copies of pictures and paper documents to the fax number below. Method 3: Electronic Mail After submitting this online application, you will receive a confirmation email. By replying to this email you can submit electronic copies of scanned images and PDFs by attaching them. Use the personalized subject provided to ensure your documents get delivered to the right place. Method 4: Online Upload Tool After you submit the online application, you can provide additional materials by using our online document upload tool. You will receive more information about the upload tool after the application is submitted. Method 5: Postal Mail Mail copies of pictures and paper documents to the address below. GreyStone Power Corporation P.O. Box 897 Douglasville, GA 30133 Phone: Fax:

Questions? Call Trisha McBee at 770-370-2273

Be sure to make copies of all mailed documents for your records!

DEADLINE FOR APPLICATIONS IS JAN. 31, 2014.