2023 Energy Camp Application
Energy Camp | May 30 - June 2, 2023
DEADLINE: MARCH 6, 2023
Please fill this application out in full.
Local Electric Cooperative
Please Select
Alfalfa
Arkansas Valley
Canadian Valley
Central
Choctaw
Cimarron
CKenergy
Cookson Hills
Cotton
East Central
Golden Spread
Harmon
Indian
KAMO
Kay
Kiamichi
Lake Region
Northeast OK
Northfork
Northwestern
OAEC
Oklahoma
Ozarks
People’s
Red River Valley
Rural
Southeastern
Southwest Rural
TCEC
Verdigris Valley
Western Farmers
Other
Student Name
First Name
Last Name
Student Email
example@example.com
Student Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Student Gender
Male
Female
Student Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student School:
Student Expected Graduation Year
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Age as of June 1, 2023
Student T-shirt Size
Small
Medium
Large
XL
2XL
3XL
Parent/Guardian Name
First Name
Last Name
Parent/Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Parent/Guardian #2 Name
First Name
Last Name
Parent/Guardian #2 Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian #2 Email
example@example.com
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LEADERSHIP QUIZ
What kind of leader are you? What or who inspires YOU?
What activities are you involved in at school and within your community?
What leadership skills have you learned by being involved in these activities?
What are you Top 3 accomplishments?
Which accomplishment is most important to you and why?
Who do you admire and why?
What's your ideal job or career and why?
What is the most courageous thing you've ever done?
What did you learn from that experience?
Why do you want to attend Energy Camp?
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Cooperative Difference Video (upload your video below)
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*
I CONFIRM I am able to attend the 2023 Energy Camp on May 30 - June 2, 2023
*
I hereby give permission for images of myself (or child), during the 2023 Energy Camp application process through video, photo and digital camera, to be used solely for the purposes of Oklahoma's electric cooperatives promotional material and publications, and waive any rights of compensation or ownership thereto.
Student Signature
Parent/Guardian Signature
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