Contact Information

First Name:*

Last Name:*

Preferred Contestant Name:*

Home Phone:*

Mobile Phone:*

Email:*

Facebook Address or N/A (Not Applicable)*

Any other Social media Addresses or N/A (Not Applicable)*

Residential Street Address:*

Mailing Address *if different

City:*

State:*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip code:*

Age:*

Date of Birth:
*eligibility requirement 18 by Jan. 1st 2023*

Parent's Names:*

Parent's Telephone:*

Parent's Address:*

City*

State:*

Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMassachusettsMarylandMichiganMinnesotaMississippiMissouriMontanaNorth CarolinaNorth DakotaNebraskaNevada New Hampshire New JerseyNew MexicoNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWest VirginiaWisconsinWyomingWashington D.C.

Zip Code:*

Emergency Contact and Phone Number:*

Tell us about yourself:

High School:*

College Major or N/A (Not Applicable)*

Year in College*

School Organization and/or Sports or N/A (Not Applicable)*

Answer the following four questions. You may attach a document to answer.

Attach file here:

Convert to PDF?
(DOC, DOCX, XLS, XLSX, TXT)

Goals and Ambitions:

County Fair Involvement and Awards:

Community or Extracurricular Activities:

Place of Employment, Start to End/Present, Work Responsibilities, Skills Learn or N/A (Not Applicable).

Reference 1:

Name:

Title/Releationship

Phone:

Email Address:

Reference 2: (optional)

Name:

Title/Releationship

Phone:

Email Address: