Teen Achieve Official Entry Form
Woman of Achievement Official Entry Form
I hereby apply to represent my STATE: ______or Region: ______in the
2016/17Woman of Achievement Pageant System.
Name:______
Div: Miss (19-26 yrs) ___ Ms.or Mrs, (26- 39) ___ Ms or Mrs,. Elite (40 & up) ____ (Circle Mrs. Or Ms). Address:______City:______County______
State ______Zip ______Cell Phone:______Alt. Phone:______
Email Address: ______Current Employment:______
Name of High School or College: ______State Attended:______
FAMILY INFO: Husband Name (if applicable) ______Children’s Names and/or Siblings:
______
Past and Current Academic Achievements & your plan for any title, recognition or award won in this competition to go back to school, bring awareness, media and/or funding to a valuable project within your community: ______
______
College & Career—what are your college plans and/or career objectives for the future? ______
______
What volunteer or charity works have you completed in the past two years or are currently involved in? ______
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If you were to win, what is the one topic you would like to emphasize to women throughout your state? YOUR PLATFORM: ______
______
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______WHAT IS YOUR “Marketing” Plan statewide and/or nationally should you win the National Title?
How would you propose to spend your year (if you were to be selected), in order to get this message to women and others (i.e., through outreach programs, school assemblies, holding programs at YMCAs, volunteering at Senior Centers, Walks for Life, Media, etc.)—how do you propose to take your message to women throughout your state?______
(OPTIONAL) Other pageants you have participated in: ______
-Page 2-
You have a choice of 1) presenting a SPEECH about your Platform, the work your are doing and have done in the past year; or: 2) Showing a Visual Media (oil painting, photography display, or other non-performance art) or 3) Classical Talent (i.e., Vocal, ballet, instrumental, modern dance, violin, dramatic monologue, etc.) Please LIST what you will plan to present at the pageant:
______
How did you hear about us? ______
What three words describe you best: 1) 2) 3)
What are you most thankful about in your life? ______
What is one of the biggest challenges you’ve had to overcome in life? ______
What would you most like to be remembered for? (What is your “life legacy” for those in your family?)
______
What do you hope to gain from your pageant experience? ______
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Why did you choose our pageant? ______
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SECONDARY TITLES I am interested in if my city or state representative has been selected:
[Must have lived, attended school or have owned property in the states/regions listed above]
1st Choice: ______
2nd Choice:______
3rd Choice:______
THE ABOVE INFORMATION IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.
Signature: ______Date: ______
Enclose a recent headshot or photo and your non-refundablesash and application fee of $130.00 to: Woman of Achievement,2616 W. Hellman Ave., Alhambra, CA 91803