role model form by 5B31i9o

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									          USA National Miss
New York/Pennsylvania Role Model
Competition Form
Please type or print neatly and email a copy to the state office by August 30, 2012. Also, bring the
original form to registration, along with any photos, letters of community service, scrapbooks, letters
of recommendations, transcripts, report cards, etc.
NOTE: You do NOT need to have entries in each area of competition in order to enter this
competition. For example, you may only community service involvements (and non of the other
areas) that you would like to enter, or you may have only academics, etc.


Name:


Division: ____Jr.Princess ____Princess ____Pre-teen____Jr.Teen____Teen____Miss


Bring ORIGINAL TO REGISTRATION

COMMUNITY SERVICE: Please list any community service activities/volunteer projects you
have participated in including hours served (attach any additional information, photos,
letters of service, etc.) ____________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________


CIVIC INVOLVEMENT: Please list any civic involvements and hours served (attach any
additional information, photos, letters of service, etc.)
_____________________________________________
_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

ACADEMIC ACHIEVEMENTS:
Grade: School: ________________________________________________________
Please attach a letter of recommendation from on of your teachers, along with a report card.


MENTORING ACTIVITIES: Please list any mentoring/assisting you have participated in:
________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

								
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