Step 1 of 2 0% Is the applicant applying for a student scholarship, or the Wallace Community College Lineworker Program?* Student Scholarship Wallace Community College Lineworker Program Applicant Name* First Last High School Name* High School Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code How well, how long, and in what capacity do you know the applicant?*Do you believe this student will continue his/her education until completion?*Successful students and graduates for the Wallace Community College Pre-apprentice Lineworkers Program are expected to arrive mentally and physically prepared; maintain a positive attitude; proficiently apply the knowledge, behavior and skills learned; and dedicate themselves to the program while on campus.*In comparison to other students whom you have known at comparable stages of development, how would you rate the applicant in the following areas? If unable to evaluate, leave blank.Seriousness of Purpose Below Average Average Above Average Excellent Initiative Below Average Average Above Average Excellent Maturity Below Average Average Above Average Excellent Adaptability Below Average Average Above Average Excellent Enthusiasm Below Average Average Above Average Excellent Emotional Stability Below Average Average Above Average Excellent Leadership Below Average Average Above Average Excellent Public Speaking Below Average Average Above Average Excellent List an example of how the student has demonstrated one of the qualities shown above. List any additional comments which you believe describe this student.Educator/Guidance Counselor Consent* I hereby verify the above information to be true and complete. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.Electronic Signature (Full Name)* Title*
