Scholarship Application

CBH CO-OP offers an educational scholarship to promote furthering education. Use the online form below, or print our scholarship application form (PDF, 310.37 KB) and return to us in person at:

CBH CO-OP
Scholarship Selection Committee
1206 S Douglas Hwy
Gillette, WY 82716

General Information

First Name *

Middle Initial

Last Name *

Birthdate *

Street

City

State

Zip

Home Phone

Cell Phone

High School

Year of Graduation

College (if applying as college student)

GPA

Class Rank & Size of Class

ACT Score

SAT Score

College/School Attending

Major

Parent or Guardian Name

Parent Email

Parent Phone #

Parent/Guardian Coop Member Account Number

Upload Your Most Recent Academic Transcript

Please include a short essay on what it means to be a CO-OP member:

Upload Essay

I have read and understand the qualifications for the CBH CO-OP Scholarship. I affirm the information contained herein is true and accurate to the best of my knowledge and belief.

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