Jim Graham Cooperative Leadership Scholarship Application
On behalf of the CCNC we hope your school year is going well and are looking forward to graduation in the coming Spring! Because you attended the Cooperative Leadership Camp at some point during High School, you are eligible to apply for a $1,000 college scholarship. Please fill out the entire application and submit by the due date. In addition, please make sure to print the instructions page and mail in your signature page with supporting documents. The winner will be honored at a luncheon at the Council's annual meeting.

Jim Graham is a renowned agricultural leader, an active supporter of the Cooperative Leadership Camp and North Carolina's former Commissioner of Agriculture.

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Eligibility Requirements:
Application Requirements:
Disbursement of Funds *
Scholarship recipient will be notified during the spring semester and will be invited to attend a special luncheon at the annual meeting. The recipient must notify the Cooperative Council when they are enrolled as a full time student in the institution of their choice. Funds will be disbursed directly to the institution by the Cooperative Council after the student has enrolled, to be used towards any educational expenses. Please type below: I Understand.
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Judging Criteria *
All applicants will be considered according to established rubric of criteria. A scholarship committee will judge the applications with emphasis on academics and grades, leadership, extracurricular activities, community involvement and demonstration of self motivation in the essay. Please type below: I Understand.
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Name: *
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Phone: *
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Address: *
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City: *
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Zip Code: *
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Date of Birth:
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High School: *
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Name of Local Newspaper: *
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College or University You Plan to Attend:
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Course of Study You Plan to Attend:
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Other Scholarships You Have Received (include amounts):
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Name of Father or Legal Guardian
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Father's Occupation:
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Father's Place of Employment
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Name of Mother or Guardian:
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Mother's Occupation:
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Mother's Place of Employment
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Student's GPA (_______ out of a _______ scale, based on ________ semesters completed):
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Class Standing(_______ in class of ________ students):
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SAT Score:
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ACT Score:
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Please describe any academic and/ or school honors (indicate the school year (s) in which you received each honor or award):
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Please describe any extracurricular activities (include any leadership positions held and the school year (S) in which you participated in each activity):
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Please describe any community, civic or other activities (include community activities, honors, leadership roles and/ or rewards):
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Work Experience (please include present and previous employment, the dates you held each position, and explain your responsibilities/ duties):
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Hobbies, Interests and Talents:
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I have read and understand the enclosed information. I affirm that the information provided on this application form and any additional material that I submit related to this scholarship process is complete, accurate and true to the best of my knowledge. I hereby authorize the Cooperative Council of North Carolina to access the scholarship application information provided by me, as well as other official and unofficial information regarding my academic progress at status, for the purpose of providing information concerning my eligibility as a scholarship recipient. I understand that furnishing false information may result in revocation of my scholarship funding, if selected as a recipient. I also understand that if selected as a recipient I do not meet the requirement of registering as a full-time student to an educational institution, I will not receive the scholarship funds. *
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Student Signature: *
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