Please complete the following form. You will be contacted by personnel from the Miss Fullerton Organization.

Vital Statistics
Contestant for Miss:
Full Name:
E-Mail Address:
Social Security:
Age:
Birthdate:
Phone:    
Address:
City:
State:
Zip:    
       
Height:
Weight:
Hair:
Eyes:
       
Parents Name:
Check box if address is the same as above:
Address:
City:
State:
Zip:
Phone:
   
Father's Occupation:
Mother's Occupation:
Names & Ages of Brothers & Sisters  
       
EDUCATION    
High School:
Graduation Date:
     
College:
Years Attended:
Declared Major and/or Minor:
Honorary Sorority:
Social Sorority:
  (Indicate if local or national or both)
   
Special Training (In music, drama, dancing, art, etc.):
Honors Won in High School:
 

OUTSIDE ACTIVITIES
Hobbies & Interests:
 
Sports Participation:
 
Work Experience:
 
Civic Organizations, Church Groups & Volunteer Activities:
 
Other Accomplishments & Interesting Facts:
 
GOALS & OTHER INFORMATION
Talent Presentation (Describe specific type and musical selection if applicable):
 
Scholarship Information (State college education, degree, and/or special training you desire in using any scholarship grant you may receive from this program):
 
Ambitions for the Future:
 

By submitting this form, I certify that the foregoing information is true and correct to the best of my knowledge.

  

 
 
Miss Fullerton Scholarship Program
Kathi Hikawa, Executive Director
650 N. Rose Drive, Box 365
Placentia, CA 92870
714.524.6096 or khikawa@aol.com
 
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khikawa@aol.com
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