Mansfield Foundation Scholarship | Claverack Rural Electric Cooperative, Inc

First and Last Name

Telephone Number

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Name on Claverack REC Account

(If different from name of applicant)

Account Number

Relationship to Claverack Account Holder

Were you a Claverack Youth Tour student in high school?

Yes

School Name

GPA

SAT

Major?

What were your various awards and achievements?

Please use this box to fill in your complete answer, use as much space as you like.

What kind of community services have you participated in?

Please use this box to fill in your complete answer, use as much space as you like.

Describe some leadership positions you have held already?

Please use this box to fill in your complete answer, use as much space as you like.

Class status at beginning of upcoming academic year:

Freshman

Sophomore

Junior

Senior

Have you applied for this scholarship before:

Yes