Scholarship Application

Personal Information
Applicant Name*
First Last
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Please provide your current home address
Pee Dee Electric Cooperative Account Number*
County of Residence*
Date of Birth*
Date Format: MM slash DD slash YYYY
Father's/Legal Guardian's Name*
Mother's/Legal Guardian's Name*
Contact Information
Phone Number*
Email Address*
School Information
Current High School*
Graduating Class Size
Current Class Rank
Current GPA*
Please list any honors, awards, scholarships or other special scholastic recognition you have received.*
In what extra-cirricular activities have you participated? Please also note any position of leadership or any special recognition received.*
What college do you plan to attend?
What field of study do you plan to enter?
Upload a photo of your transcripts
Accepted file types: jpg, jpeg, png, pdf.
Essay Questions
What would it mean to you and your family if you were to receive this scholarship and what career plans fo you have in utilizing it?*
How has Pee Dee Electric Cooperative made an impact in your life?*

Personal Information