Miss Seattle Scholarship Pageant Online Application

Please fill in all the blanks on the following form. Make sure all information is accurate, as
on-stage information may be taken from this form.

Personal Information

Your Full Name:

Your Email Address:

Age:
(As of 9/15/07)

Date Of Birth:
(xx xx xxxx)

SSN:

Current Address:

City/State/Zip:

Permanent Address:

City/State/Zip:

Telephone:
(Daytime/Evening)

Day

Evening

Education

High School:
(Name/City/State)

(Name/City/State)

Year of Graduation:

College:		Years Attended:
Year Of Graduation:		Class of (As Of September 2007)

Graduate School:		Years Attended:
Year Of Graduation:		Class (As Of September 2007)
Declared Major:		Declared Minor:

Scholastic Honors

Scholastic Ambition

Career Ambition

Talent

You need not give the exact title of your talent presentation here. Merely the type of talent: dance (ballet, tap, etc), vocal, (Classical, pop, etc.), play a musical instrument (clarinet, piano, etc.), dramatic presentation, etc. Talent presentations are limited to two minutes.

What type of talent will you present?

Special training in music, drama, etc.

General Information

The Miss America Organization encourages the young woman who participate in the program to become involved in their communities and to speak out on issues of concern to, their community and the nation. If selected the winner of this competition, what issue would you choose to focus on during your year of service?

Community Service/Volunteer Activities

Fathers Name:

Fathers Occupation:

Mothers Name:

Mothers Occupation:

Interesting Facts About Yourself

Health and Fitness Interests

Hobbies