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2017 Hoosier Boys State Delegate

Nomination Application
Due to Mr. McDonough in the Counseling Office by February 24, 2017
Please do not handwrite your application. The form must be completed electronically and printed.
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  • For Junior Males Only
  • Must have a 3.0 cumulative Grade Point Average
  • Four Delegates and two alternate delegates will be selected to represent CHS
  • Must be able & willing to attend full conference at Trine University (June 11-17, 2017)
  • If selected to represent Carmel High School, student must provide a physical exam form completed by a physician (or a copy of an IHSAA athletic physical for the current year)
  • Delegate nominees will be notified of their selection on February 28th and will be asked to complete the “official” (and brief!) Hoosier Boys State application for the American Legion by March 6, 2017.
  • Sponsors will cover the $300 fee involved in attending the conference
  • Please ask 2-3 teachers (it is highly recommended that you ask at least one Social Studies teacher) to submit a recommendation on your behalf to Mr. McDonough by February 24, 2017.

I understand each of the requirements listed above:______Student Signature

Section 1: To be completed by student
Student Name:
Address:
Phone: / Alt. Phone (Cell):
SRT Room/Teacher:

Activities and Leadership

Name of Activity / Dates Participated / Leadership Position

Service

Type of Service/Location / Hours per week / Dates Involved

Personal Statement

What unique qualities do you think you will bring to the Hoosier Boys State experience? What do you think you will take from it?

2017 Hoosier Boys State Teacher Recommendation
TEACHERS: Please return to Mr. McDonough in the Counseling Office by February 24, 2017
Teacher recommendation can be handwritten or attached to this document.
Student Name:
Evaluator Name:

Please rate the student on the following qualities:

Quality / Excellent / Good / Average / Below Avg
Citizenship/Character
Academic Curiosity
Leadership Potential
Openness Toward Others
Community Service
Interest in Gov/Politics
Overall Evaluation for HBS

Comments:

Teacher’s Signature: Date:
2017 Hoosier Boys State Teacher Recommendation
TEACHERS: Please return to Mr. McDonough in the Counseling Office by February 24, 2017
Teacher recommendation can be handwritten or attached to this document.
Student Name:
Evaluator Name:

Please rate the student on the following qualities:

Quality / Excellent / Good / Average / Below Avg
Citizenship/Character
Academic Curiosity
Leadership Potential
Openness Toward Others
Community Service
Interest in Gov/Politics
Overall Evaluation for HBS

Comments:

Teacher’s Signature: Date:
2017 Hoosier Boys State Teacher Recommendation
TEACHERS: Please return to Mr. McDonough in the Counseling Office by February 24, 2017
Teacher recommendation can be handwritten or attached to this document.
Student Name:
Evaluator Name:

Please rate the student on the following qualities:

Quality / Excellent / Good / Average / Below Avg
Citizenship/Character
Academic Curiosity
Leadership Potential
Openness Toward Others
Community Service
Interest in Gov/Politics
Overall Evaluation for HBS

Comments:

Teacher’s Signature: Date:
Parent Endorsement
Hoosier Boys State Participation

I support my son,______, in his application for Hoosier Boys State and verify that, if selected to represent Carmel High School, he will be available to complete the full program at Trine University on June 11-June 17, 2017.

Parent Signature Printed Name Date