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2013 Scholarship Application Student Information: Name:______________________________________________________ Address:___________________________________________________ City:________________________________________________________ State:______________________ Zip:____________________________ Email:_________________________________________________________________________ Phone:__________________________________ Name of High School:___________________________________________________________ Date of Graduation:_______________________ To be eligible for this scholarship, the student’s parent or guardian MUST be a member of Powder River Energy Corporation Full Name: Father/Guardian:_____________________________________________________ Employer: _______________________________ Full Name: Mother/Guardian:_____________________________________________________ Employer:________________________________ I plan to attend school at:_________________________________________________________________ Beginning:______________________ Please provide address of school treasurer/tuition office and contact name: This information is to be included in a complete format to be considered a valid application. College Contact:________________________________________________________________ Phone: __________________________________ College Address:________________________________________________________________________________________________________ City:________________________________________________________ State:______________________ Zip:____________________________ Please complete the following: (scores if applicable) ACT_________________ SAT___________________ G.P.A.__________________ Class Rank________________ Out Of__________________ Miscellaneous Information: (attach additional sheets as needed) Attach transcript of grades (can be from online). Compose a brief essay/description of: • Activities you have participated in school and in your community, including employment, volunteer activities, and hobbies. • Your financial need including other scholarships awarded, plans for financial support including grants, family assistance, etc. • General information about yourself which would provide a fuller portrait of you as applicant. Submit one reference from a teacher, counselor, or employer. Return application and other documentation to: Powder River Energy Corporation Attn: Marketing Communications Division PO Box 930, Sundance WY 82729 For more information: Deadline: Must be received in our office by May 31, 2013

SUNDANCE – CORPORATE HEADQUARTERS 221 Main Street • P.O. Box 930 • Sundance, WY 82729 (800) 442-3630 Phone • (307) 283-3527 Fax

GILLETTE 200 Garner Lake Road • P.O. Box 937 • Gillette, WY 82718 (800) 442-3630 Phone • (307) 682-0733 Fax

SHERIDAN 1095 Brundage Lane • P.O. Box 5087 • Sheridan, WY 82801 (800) 442-3630 Phone • (307) 674-9018 Fax

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