Ms., Miss & Teen Contestant Application Form

INSTRUCTIONS: The Contestant Application Form must be COMPLETELY filled out to be considered for the Southwest Michigan Scholarship Program. Use only the space provided. NO ADDITIONAL SHEETS WILL BE ACCEPTED. After filling out the Contestant Application Form, hit submit and mail entry fee of $100 and copy of birth certificate to Southwest Michigan Scholarship Program, P.O. Box 623, St. Joseph, Michigan 49085. If you have questions, please feel free to email or call the Executive Director, Frederic Zoschke at frederic@misssouthwestmichigan.org or 269-428-4999.

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Name (Full Legal Name):

    

Entry Code

Age:

Date of Birth:

Check One:

Teen

Miss

Ms.

Applicant Email:

Address:

Home Phone:

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Cell Phone:

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School Name:

School Address

School Phone:

Parent(s) Name(s):

Parents' Address:

Parent Email:

Home Phone:

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Parent Cell Phone

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Fathers Occupation:

Mothers Occupation:

Names & ages of Brothers & Sisters:

Were you born & raised in the present community? If no, where?

Why did you decide to enter this program?

If you are selected as the next Representative what platform or issue will you raise money and speak on throughout your year of service for?

High School:

Date Graduated:

College:

Date Graduated:

College Major:

Declared Minor:

Degree Received:

Graduate School:

Degree:

Scholastic Honors:

Career Ambition:

Other Accomplishments:

Community Involvement and Volunteer Work:

Who or what is your favorite charity and why?

Hobbies:

Sports

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We will agree to the rules and regulations stated by the Southwest Michigan Scholarship Program within this agreement by signing this Contestant Application Form.  We hereby state that all information contained in this Contestant Application Form is true.  Any misrepresentation of the truth will cause immediate disqualification from competition.  Any fees paid are non-refundable.  Information must be typed and limited to Contestant Application Form. 

Contestant's Signature:

Date

Parent's Signature

Date

Parent's Signature:

Date

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The Southwest Michigan Scholarship Program is not affiliated with the Southwest Michigan Scholarship Pageant, the Miss Michigan Scholarship Pageant, Inc., or Miss America Organization. 

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