Full Name
Local Title
Eye Color
Hair Color
Hometown
School Attending(if applicable)
Year of Graduation
Major
Ambition
Ambition contd
Pets
Siblings
Most interesting spot in hometown
Most famous I've met
Person I would like to meet & why
Person I would like to meet & why contd
Best Advice I've ever received
Best Advice I've ever received contd
My greatest achievement
My greatest achievement contd
My secret to success
My secret to success contd
People would be surprised to know
People would be surprised to know contd
What makes me happy
Biggest extravagance
One thing always in my refrigerator
My best trait
My worst trait
I never leave home without
Beauty Tip
Favorite Celebrity
Favorite Movie or TV Show
Favorite School Subject
Favorite Song or Music Group
Favorite Sport or Activity
Favorite Vacation
Favorite Gift Received
Signature of Contestant
Signature of Contestant-39-11-1
Signature of Parent/Guardian(if Contestant is under 18)40-12-2
Signature of Contestant-41-12-1
Printed Name(Parent/Guardian)42-12-2
Date(Contestant)43-12-1
Printed Name(Contestant)44-12-1
Signature of Parent or Guardian-45-13-2
Signature of Contestant-46-13-1
Parent or Guardian Name-47-13-2
Contestant's Name-48-13-1
Policy and Group Number-49
Phone
Name of medical insurance carrier-51
List any and all handicaps or impairments that apply to you-52
If so please explain-53
Have you recently had any serious illness accident or surgery contd 54
Have you recently had any serious illness accident or surgery 55
If so explain-56
Do you have any ongoing conditions for which you are currently taking medication or being treated for-57
Additional medicine information not previously stated-58
List any all medicine that you are currently taking prescription or nonprescription contd 59
List any all medicine that you are currently taking prescription or nonprescription-60
If so list-61
Are you allergic to any medication or foods-62
Physician Phone Numbers-63
Family Physician-64
Emergency Contact Phone Numbers-65
Emergency Contact Address-66
Relationship-67
Emergency Contact-68
Parent/Guardian Names if Contestant is under 18 years-69
Full Address-70
Date of Birth-71
Mess-72
Cell
Todays Date-74
Contestants Full Name-75
Signature of Parent/Guardian-76-14-2
Signature of Contestant-77-14-1
Date_2-78-12-2
Parent/Guardian Printed Name-79-14-2
Printed Name of Entrant-80-14-1
Parent's Signature(if Contestant is in the TEEN division)-81-15-2
Contestant's Signature-82-15-1
Todays Date_2 83-15-2
Parent/Legal Guardian SIGNATURE-84-16-2
Parent/Legal Guardian PRINTED NAME84-16-2
Contestant's SIGNATURE-86-16-1
Contestants PRINTED NAME-87-16-1
Birth Certificate2
State Residency Proof1
State Residency Proof2
Official State Entry Form
GPA Report
Online Bio
Online Video
Page 11