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2026 Youth Tour Participant Information Request

Comments

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Your sponsoring electric cooperative, Arkansas Electric Cooperatives, Inc. (AECI), and the National Rural Electric Cooperative Association (NRECA) collect the information contained in this form to register for Youth Tour and to provide or arrange first aid and other medical treatments for participating students of the Electric Cooperative Youth Tour to Washington. We reserve the right to refuse participation to your child in the tour in the event you refuse to provide the requested information. The information collected will be kept by AECI and NRECA staff and made available to medical staff in the case of an accident or emergency. This information is not shared for any other purpose.

PERSONAL DATA

Name:(Required)

First Middle Last Suffix

Preferred Name for Name tag:(Required)

Driver's License or Official State Identification(Required)

We need a scan or digital photograph of your driver's license or official state identification. As of May 7, 2025, anyone who boards a domestic flight or enters a federal building will either need a REAL ID driver’s license (DL) or Identification Card (ID).

Upload a scan or digital photograph of your identification here:

Max. file size: 256 MB.

Digital Photo(Required)

We need a digital portrait photograph of you for our delegate directory.

Head shot photos are preferred, such as senior, prom or yearbook photos. No selfies please.

Upload your photo here:

Max. file size: 256 MB.

Social Security Number(Required)

This is required to submit for a tour of the White House and the FBI Headquarters. While we are not guaranteed that these tours will be accepted, this information is required to submit a request. This information will be kept confidential to only the Arkansas Youth Tour Director and Federal entities requesting it.

Sponsoring Electric Cooperative(Required)

Select the cooperative that selected you as a Youth Tour delegate.

Select the member of Congress who represents your district:(Required)

Birthdate (mm/dd/yyyy):(Required)

Age(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone/Student Phone:(Required)

Email Address:(Required)

U.S. Citizen:(Required)

Yes

Gender:(Required)

Male

Female

Country of birth:(Required)

High School Name:(Required)

Parent(s)/Guardian(s) Names(s):(Required)

Phone number for mother or guardian:(Required)

Phone number for father or guardian:(Required)

Parent/Guardian Email Address:(Required)

Additional Parent/Guardian Email Address:

Parent and Student Orientation Luncheon(Required)

Parents are invited to attend the Parent and Student Orientation on June 13 at 12 p.m. noon. Space will be limited, so we ask you limit guests to two parents/guardians/siblings. Please indicate the number of parents/guardians/siblings who will attend the luncheon in ADDITION to the students.

Shirts

Students will be provided shirts for each day of the trip. T-shirts will be worn most days. T-shirts will be provided in unisex sizes. On the day we take photos with our Congressional delegation, we will wear polo-style shirts. These polo-style shirts are offered in a ladiesʼ cut which can sometimes differ from unisex T-shirt sizes. For the female students whose T-shirt sizes may differ from ladiesʼ fit polo shirts, please indicate the correct size for both.

T-Shirt Size:(Required)

Ladies' Cut Polo-Shirt Size:

(For female students only. Male students will receive polo shirt size according to T-shirt size)

MEALS

The Electric Cooperatives of Arkansas will cover all expenses for meals, lodging and tours. Some group meals will be buffets, while others will allow participants to select their own options.

Specify any food allergies or dietary restrictions (If none, write "N/A".)(Required)

NRECA REGISTRATION & MEDICAL RELEASE

The National Rural Electric Cooperative Association's (NRECA) registration and medical release form must be completed. All NRECA rules and policies also pertain to Arkansas Electric Cooperatives, Inc. (AECI).

Please visit this link to complete the registration and medical release for the National Rural Electric Cooperative Association: NRECA Registration & Medical Release.

Student Signature agreeing to NRECA's Registration and Medical Release(Required)

Parent or Guardian Signature agreeing to NRECA's Registration and Medical Release(Required)

CUSTODY RELEASE (for Airport Pick-Up on June 19)

Who will pick your student up at the airport?(Required)

Parent or Guardian Signature(Required)

DESIGNATION OF BENEFICIARY

Arkansas Electric Cooperatives, Inc. purchases accident insurance coverage for each Youth Tour participant that is effective from the time the participant leaves his/her residence to participate in the tour until he/she returns to Little Rock. This form names a beneficiary for the $10,000 benefit.

Name of Participant:(Required)

First Last

Street/Rural Route/PO Box(Required)

Street Address Address Line 2 City State ZIP Code

I do hereby designate:

Name of Beneficiary:(Required)

This is usually a parent or guardian

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

As my insurance beneficiary during the 2026 Electric Cooperatives of Arkansas Youth Tour during the week of June 13-19, 2026.

I understand that this insurance, purchased by Arkansas Electric Cooperatives, Inc. will be in effect from the time I leave Little Rock, Arkansas, on said Youth Tour until the time I return to Little Rock, Arkansas, from Washington, D.C., on said Youth Tour.

Participant Signature(Required)

TELL US ABOUT YOURSELF

School activities, honors, awards, offices held, etc. Please list activities you have participated in and any special honors you have received, such as class officer, plays, music, athletics, FFA, 4-H, church, service or community groups, etc.(Required)

List any public speaking experience:(Required)

Hobbies, special interests:(Required)

What is your career goal?(Required)

Any additional information you would like to share about yourself?

YOUTH LEADERSHIP COUNCIL DELEGATE

Each state selects one student to represent them in NRECA's Youth Leadership Council program. The selected delegate will receive a $5,000 scholarship. REQUIREMENTS INCLUDE: The YLC Delegate is required to attend the NRECA Youth Leadership Council meeting held July 20-24 in Washington, D.C.; the Electric Cooperatives of Arkansas' Summer Directors' Meeting, July 27 in Hot Springs; and the 2027 NRECA PowerXchange conference Feb. 12-17 in San Diego, California. By selecting "yes" below, you are submitting your application to be considered. Delegates will be chosen through an online interview process in early June. Finalist will chosen by their peers during the trip.

Are you interested in applying to the Arkansas Youth Leadership Council Delegate?

Yes

STUDENT JOURNALIST FOR A DAY

Are you interested in applying to be a student journalist for a day?

Yes

Each day on Youth Tour, a different student journalist will write an essay of the day's events for Arkansas Living magazine. The essay will be due after Youth Tour is over, and journalists will receive a gift card for their participation.

PHOTO/VIDEO RELEASE

CODE OF CONDUCT

Parent Signature(Required)

Student Signature(Required)