Homecoming Court Personal Information

(Required Fields = BOLD)

First Name:
Middle Name:
Last Name:
Email Address:
Permanent Home Address:
Home City:
Home State:
Home Zip:
Local Address:
Local City:
Local State:
Local Zip:
Local Phone:
Cell Phone:
Number of Credits To Be Completed By 9/01/11:
College(s):
Major(s):
Cumulative GPA:
   Study Abroad:    Yes: No:
If Yes, Location/Dates:
Nominator Name:
Nominator Department:
Nominator Relationship to Nominee:
High School Name:
High School Address:
City:
State:
Zip:
Year of Graduation:
Home Town Newspaper:
Shirt/Sweater Size: