Contestant Application Form

Would you like to participate in the Distinguished Young Women scholarship program? Complete the form below and press the 'Submit Application' button. Items in red are required.

Contact Information
If you cannot complete a required field, please contact us for assistance.
First Name
Middle Name
Last Name
Street 1
Street 2
Street 3
City
State
Zip Code
County, Parish or Borough
Phone (Home)
Phone (Cell)
E-mail Address
Confirm E-mail
Requirements
In addition to the following requirements, contestants must compete in all of these categories: Interview (25% weight), Talent (25%), Scholastics (20%), Fitness (15%) and Self-Expression (15%).
U.S. Citizen? yes no
Ever Married? yes no
Ever Pregnant? yes no
Graduation
Don't make this common mistake: If your senior year begins in 2013, for example, then you will likely graduate in the Spring of 2014. Also, for some states, competition begins as early as your Junior year, so apply early!
When will you Graduate
from High School?