Contact Us Employment Application Operation Roundup Scholarship Send Us A Message Your Name Your Email? Your Phone Number Subject Message CAPTCHA Math question 15 + 0 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Your Information First Name Last Name Gender Male Female Other… Enter other… Contact Information Contact Email Phone Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Your Resume Attach resume file Paste your resume Resume One file only.15 MB limit.Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods. Resume Status message You must be an active member to apply for individual or family funds. All individual or family applications must be accompanied by a referral letter from a local social service agency. Please review the Trust Funding Guidelines. PLEASE REVIEW YOUR APPLICATION BEFORE SUBMITTING. Incomplete forms or insufficient information will cause your application to be returned or denied. Applications must be received by the deadline. Applications received after this date will be held for the next meeting. NOTE: Operation Round Up does NOT assist with utility, rent or mortgage payments. Applicant Information Name: Member Account Number: Phone Number Email Applicant Address Mailing Address Address Address 2 City/Town State - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Do you have a different physical address? - Select -YesNo Physical Address Physical Address Address 2 City/Town State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code How long have you lived here? Do you own or rent? Do you own or rent? - Select -OwnRent Employment Information Are you employed? - Select -YesNo Employer: Title: How long have you worked here? Wages: $ Other Residents Do you have a co-applicant? (i.e. a spouse, partner, etc. Must reside in the same house) - Select -YesNo Name: Relationship: How long have you lived here? Phone Number Employment Information for Co-Applicant Are you employed? - None -YesNo Employer: Title: How long have you worked here? Wages: $ Dependents Please list all dependents in the field below. Include names, ages and relationships to you. Assets Do you have a bank account? - Select -YesNo Savings Account Balance: $ Checking Account Balance: $ Do you own real estate? - Select -YesNo Location of real estate: Market Value: Do you own any vehicles? - Select -YesNo Vehicle #1 Vehicle #1 Make: Year: Model: Market Value: $ Select to add another vehicle. Vehicle #2 Vehicle #2 Make: Model: Year: Market Value: $ Select to add another vehicle. Vehicle #3 Vehicle #3 Make: Vehicle #3 Model: Year: Market Value: $ Other Income If none, type 0 in the applicable box. VA: $ SSI: $ SSA/SSDI: $ Pension: $ Child Support: $ Spousal Support: $ Other Income: $ Explain other income: Debt and Loans Credit Card Debt? - Select -YesNo How many cards? Are you current on payments? - Select -YesNo Total owed: $ Auto Loan? - Select -YesNo Monthly auto loan payment: $ Are you current on payments? - Select -YesNo Child Support (paid): $ Do you owe back child support? - Select -YesNo Total back child support owed: $ Medical bills: $ Monthly Expenses If none, type 0 in the applicable box. NOTE: Operation Round Up does NOT assist with utility, rent or mortgage payments. Rent/Mortgage: $ Avg. Monthly Electric bill: $ Gas for your vehicle: $ Monthly Grocery Bill: $ Gas/Propane for home: $ Water/Sewer/Trash: $ Telephone/Cell phone: $ Cable/Satellite/Other service provoder: $ Monthly Internet bill: $ Medication costs: $ Monthly Tax Payments: $ Other monthly expenses: $ Request Information What is your request? Be specific. NOTE: Operation Round Up does NOT assist with utility, rent or mortgage payments. Amount being requested (Max $2,500): $ Please upload a referral letter from a local social service agency below. One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. List social service/charitable agencies providing assistance to any member of the household. (Include energy assistance, food stamps, WIC, etc.) How did you learn about the Kootenai Electric Trust/Operation Round Up program? Reference #1 Name Phone Reference #2 Name Phone Reference #3 Name Phone I agree to the following: The information contained in this statement is for the purpose of obtaining funding from the Kootenai Electric Trust on behalf of the undersigned. Each undersigned understands that the information provided herein is used in deciding to grant funding, and each undersigned represents and warrants that the information provided is true and complete and that the Kootenai Electric Trust may consider this statement as continuing to be true and correct until a written notice of a change is provided. The Kootenai Electric Trust is authorized to make all inquiries they deem necessary to verify the accuracy of the statements made herein. We understand that if we are selected for funding by the Kootenai Electric Trust our name may be used in the promotion of the Operation Round Up Program. PLEASE REVIEW YOUR APPLICATION BEFORE SUBMITTING. Incomplete forms or insufficient information will cause your application to be returned or denied. Applications must be received by the deadline. Applications received after this date will be held for the next meeting. Signature of Applicant Sign above Today's Date Applicant Name Applicant First Name Applicant Last Name Mailing Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Email Phone Number Parental information is not required of adult, non-dependent applicants. If adult applicant is married, spouse’s information must be included. Parents’ or Spouse’s Name(s) Father or adult applicant's place of employment Mother or Spouse’s place of employment Did you receive a high school diploma or equivalent? Yes No High school or college grade point average (4.0 point scale) ACT Score SAT Score If none, please explain. Are you currently attending school? Current enrollment is not required to apply. Yes No If yes, where are you attending school? If no, where and when did you last attend school? What post-secondary institution do you plan to attend? What do you plan to major in? What are the tuition and fees per year (not including room and board)? $ What date do you plan to attend that post-secondary institution? Status message How much other financial aid have you received to date? Loans: $ Scholarships or Grants: $ Total gross income for household $ Number of family members residing in household Other factors which influence financial need What is your understanding of Operation Round Up program (describe in your own words)? Please attach the following: High school transcript or current college transcript (last two years). Attach explanation if not available. One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Provide a one-page essay (up to 400 words, double-spaced with 12-point font): In the essay, tell us about yourself (such as: interests, background, hobbies, interesting experiences) and who/what has influenced your selection of a college major. One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Status message Video and Photo Requirements for Application Upload a high resolution copy of your senior picture to: https://www.dropbox.com/request/2igua3VvJ8wjWaLHGO24 Create a video (1-2 minutes) and include: Your first and last name. The high school you are going to graduate from (if applicable). The school you plan to attend. Your major (if you know it). What is something about you that people would be surprised to learn? Please follow these tips while filming your video: Record with your phone horizontally (landscape). Limit background noise. Stand facing a window to ensure your face has good lighting. Dress in business casual attire. Upload the video here when complete: https://www.dropbox.com/request/2igua3VvJ8wjWaLHGO24 Scholarship videos will be used during the application review process. Winners' photos and videos will be featured on Kootenai Electric Cooperative’s social media, web site and newsletter. Two letters of recommendation. Letter of recommendation #1 One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. Letter of recommendation #2 One file only.100 MB limit.Allowed types: gif, jpg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip. A list of extracurricular activities, memberships in organizations, honors and other recognitions. Applicant's Signature Sign above I certify that all information reported on this application is true and correct to the best of my knowledge. (Proof of financial information and student id may be required if scholarship is awarded.) CAPTCHA Math question 6 + 13 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4. This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
