Full Name:

Age:  

Home Address:

City: State: Zip:

Phone:    Alternate Phone:

E-mail:

Parents Name(s):

High School:

Date Graduated:

College:

College Class Standing This September:

Years Attended:

College Major:    Declared Minor:

Special Training in Music, Drama, Dancing, Art, Etc.:




What Type Of Talent Will You Present:
(You need not give the exact title of your talent presentation here. Merely indicate if you will dance (ballet, tap, etc.), sing (classical, popular, etc.), comedy reading or dramatic skit, etc.

What Type Of Platform Will You Present:

What Are Your Hobbies:

What Honors Have You Won In High School:

What Honors Have You Won In College:

What Are Your Other Accomplishments. Are You A Member of Any Civic Group Or Organization Or Church/Religious Groups:

What Is Your Carrier Ambition For The Future:

I Certify That The Foregoing Information Is True And Correct To The Best Of My Knowledge.

Contestant Signature:
Please sign your name above if you are faxing or mailing this application to us. If you are submitting this form via the internet, please type your full name in the space above.

Date: