National Institute on Cooperative Education
Outstanding Youth Scholar Application Form
(Please type or word process in a similar format. Additional space may be used if necessary.)
Basic information:
Name (last, first, middle):
Nickname, if any:
Date of birth:
Male or female:
Address:
City, state, zip:
Phone:
Fax:
Name of parent/guardian:
School information:
Name of school:
Address of school:
Class year:
Favorite subject(s) and why:
Activities:
Exhibited leadership:
Extracurricular participation:
Major (if college):
Email:
Are you employed? If yes, where? What are your primary responsibilities?
About cooperatives:
In what ways do you see cooperatives as a tool for people to achieve together what one cannot do
alone?
The future:
What are your personal goals?
How do you plan to achieve them?
From among all of the candidates, why should you be chosen as the 2012 NICE Outstanding
Youth Scholar?
What is the name and address of your hometown newspaper?