OFFICIAL CONTESTANT APPLICATION
PROGRAM: (Please Select One)Miss Clark County
I am at least 17, graduating from high school in June 2016 and I will be no older than 24 on December 31, 2016.
Areas of competition: Interview, Talent, Evening Gown, On-Stage Question, Lifestyle & Fitness in Swimwear
Miss Clark County’s Outstanding Teen
On the pageant date, I will be at least 13, and I will not graduate in June 2016.
Contestant may not be 18 years old before July 31, 2016
Areas of competition: Interview, Talent, Evening Gown, On-Stage Question, Lifestyle & Fitness in Sportswear
PROGRAM ELIGIBILITY: (additional criteria in contestant contract)I qualify for this program in one of these areas:
My permanent address is in Clark County (minimum 6 months)
I am a full-time student in Clark County
I work full-time in Clark County.
PERSONAL INFORMATION:Name: (First Middle Last) / Date of Birth: / Age:
Address: / City: / State: / Zip:
Cell Phone:
() / Home Phone:
() / Email:
COMMUNITY SERVICE PLATFORM ISSUE: participant must have a Community Service Platform issue to promote
PLATFORM ISSUE STATEMENT: (100 characters or less)
TALENT:
Contestant Talent:
(Talent examples: jazz dance, clogging, vocal, monologue, Karate, gymnastics, piano, violin, etc.)
- MISS & TEEN contestant talent must not be more than 90 seconds and approved by Executive Producers
- All props require pre-approval of the Executive Producers and are the responsibility of the contestant
Miss contestants must register and raise a minimum of $100 for Children’s Miracle Network, Miss America’s national platform.
SCHOOL INFORMATION: Attach ONE copy of official transcript & ONE copy of diploma(s) if applicable
School Currently Attending: / Cumulative G.P.A.: / Grade Level or Class Status:
College Major/Intended Major: / Graduation Date (mm/yy):
Scholastic Honors: (Highlights)
EMPLOYMENT INFORMATION: (if applicable)
Current Employer: / Address: / Phone:
Manager:
EMERGENCY INFORMATION:
KNOWN MEDICAL CONDITIONS &/or ALLERGIES: (i.e. food allergies, asthma etc.)
Emergency Contact Name: / Relationship to Contestant: / Home Phone:
( ) / Alternate Phone:
()
Emergency Contact Name: / Relationship to Contestant: / Home Phone:
( ) / Alternate Phone:
( )
INTERESTING INFO: (Sports, hobbies, interesting facts, travel, etc.)
OFFICIAL PHOTO RELEASE:
I give permission to be photographed and/or videotaped by MCCSO in conjunction with all activities associated with the Miss Clark County/Miss Clark County’s Outstanding Teen/Princess programs. These photos may be used on MCCSO website, social media site, newspaper, and/or other official printed publications.
I do NOT give permission to be photographed and/or videotaped by MCCSO in conjunction with all activities associated with the Miss Clark County/Miss Clark County’s Outstanding Teen programs.
SIGNATURE: I hereby certify that this application is true and correct to the best of my knowledge. I will meet the time commitment and responsibilities set forth by this program.Signature: / Date: / Parent Signature: (if under 18) / Date:
APPLICATION PROCESS:
1. Completion of Official Contestant Application
2. Official MCCSO Contestant Orientation: November 8, 2015 attendance is required
3. The following three (3) documents will be distributed at orientation and must be submitted on or before: December 8, 2015
- MAO/MAOT Local Contestant Contract must be notarized
- Draft of Platform Statement examples will be provided
- Draft of Resume examples will be provided
4. All contestants will be required to attend workshops and Talent Review.
5. All contestants are asked to sell program book advertisements – more info to follow
- Miss & Teen Contestants – sell 2 full program page ads at $250 each
- All ads are due January 20, 2016
Please complete and email your application to:
or mail to: MCCSO
715 NW 151 Street
Vancouver, WA 98685
NOTE: Contestant Application is required to be
submitted to reserve your spot on the 2016 MCC/MCCOT Contestant roster.
If the roster has been filled, a waiting list will be started.
*The above dates subject to change