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Youth Tour Application

Name(Required)

First Last

Date of Birth (mm/dd/yyyy)(Required)

Age(Required)

Grade(Required)

School(Required)

I do have a Ben Lomand Connect service at my residence(Required)

Yes

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Guardian's Name(Required)

Guardian's Email(Required)

Guardian's Phone(Required)

1. Briefly Explain how a rural telephone and Internet cooperative operates to serve its members:(Required)

2. Personal achievements (non-school activities) for which you are most proud.(Required)

3. School related achievements for which you are most proud.(Required)

4. All Activities School and Non-school related during middle and high school years. Include activity and number of years.(Required)

5. Future Educational Goals(Required)

6. How does having high-speed broadband enhance your life and the life of your family?(Required)

7. In terms of personal development, what is your greatest strength and how has it enhanced your life?(Required)

8. What do you hope to learn about how high speed broadband is brought to rural America? (Such as technology, the process, the political factors or what interests you the most)(Required)

9. Please give an explanation of why you feel you should be chosen as Ben Lomand Connect’s representative for the FRS Youth Tour.(Required)

Applicant Electronic Signature (Full Name)(Required)

Name

This field is for validation purposes and should be left unchanged.

Youth Tour Application

McMinnville

Crossville

Sparta

Tracy City

Spencer

Manchester

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