Fillable Form 401: Mosaic Telecom $1,000 Scholarship Application (Wisconsin Indianhead Technical College)

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Form 401: Mosaic Telecom $1,000 Scholarship Application (Wisconsin Indianhead Technical College)

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401
S. 1st Street, PO Box 664 | Cameron, WI 548222
P: 715.458.5400 | F: 715.458.2112
www.MosaicTelecom.com Page 1 of 3
Mosaic Telecom $1,000 Scholarship Application
Students Attending 2021 WITC Broadband Academy
To be considered for the one (1) available scholarship, the following criteria must be met:
Candidate must be a high school senior or non-traditional student graduating in 2021
that plans to enroll in the 2021 Broadband Academy at WITC.
Parent(s) or Guardian(s) of the student to preferably reside in Mosaic Telecom’s serving
area and subscribe to one or more Mosaic Telecom service(s).
Scholarship will be awarded to individual who meets eligibility requirements and submits
the winning essay
Entries must be a minimum length of 750 words and may not exceed 1000 words
To be considered, essay entries must be accompanied by completed application and a
senior photo
Entries should be submitted before the application deadline of Friday, March 12
th
, 2021
via Mail, Email, or In-Person.
Mail: Mosaic Telecom
Attn: Scholarship Committee
P.O. Box 664
Cameron, WI 54822
Email: Marketing.Team@MosaicTelecom.com
In person: Any Mosaic Retail Store (Barron, Rice Lake, Cameron, Chetek)
All decisions made by the Scholarship Approval Committee are final including those on
selection of scholars and procedures.
Questions regarding the scholarship program should be directed to the Marketing Department
at Marketing.Team@MosaicTelecom.com or 715-458-5400.
40
1 S. 1st Street, PO Box 664 | Cameron, WI 548222
P: 715.458.5400 | F: 715.458.2112
www.MosaicTelecom.com Page 2 of 3
ALL FORMS ARE TO BE LEGIBLE
Applicant Information
Last Name First Name Middle Initial
Applicant’s Telephone Number
Applicant’s Street Address
City State ZIP Code
School District Currently Attending
Parent(s) or Guardian(s) Information
Last Name First Name Relationship to Applicant
C
ontact Telephone Number(s): (____) _____ - ____________ (____) _____ - ____________
Street Address
City State ZIP Code
I
confirm that I currently live in the Mosaic Telecom service area and our household currently subscribes
to at least one Mosaic Telecom service (Internet, Telephone and/or TV). YES NO
A. ACADEMIC INFORMATION
Name of High School you currently attend: __________________________________________
Name of University or College you will be attending:
______________________________
Desired course of study (or major). (You may indicate more than one or you may answer “undecided”):
________________________________________________________
B. YOUR SCHOOLING
List any academic distinction or honors you have received & grade level of each (9, 10, 11, 12).
ACADEMIC HONOR OR DISTINCTION
GRADE LEVEL
40
1 S. 1st Street, PO Box 664 | Cameron, WI 548222
P: 715.458.5400 | F: 715.458.2112
www.MosaicTelecom.com Page 3 of 3
C. YOUR ACTIVITIES
Note those activities in which you have been actively engaged and which you feel have been most
m
eaningful to you.
ACTIVITY
# OF YEARS
PARTICIPATING
GRADE LEVEL
ANY OFFICES HELD
D. VOLUNTEER HOURS
WITH/FOR
VOLUNTEER ACTIVITY
ESTIMATED HOURS
VOLUNTEERING OVER
THE PAST 4 YEARS
E. ESSAY
On a separate sheet of paper, type a statement of 750 words and not exceeding 1000 words, answering
this question:
What does the future of Broadband hold AND why did you choose to attend the
2021 WITC Broadband Academy?
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Form 401: Mosaic Telecom $1,000 Scholarship Application (Wisconsin Indianhead Technical College)

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Completed 11 October 2020

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