State Only:

National:

Full Name:

Age:  Date of Birth:  State of Birth:

Permanent Mailing Address:

City

  State   Zip Code

Home Phone Number: 

Email:

Do you attend school?

  Where?   Grade:

Parent's Names:

Honors:

Scholastic Achievements:

Tell us why you love the USA???

How do you show your support of the red, white, and blue?:

Are you a Christian?:

  If so, where do you attend church?

And if so, please share a brief testimony:

Do you pray daily for our country, soldiers, and president?

  Have you ever volunteered for a non-profit or government Organization? 

If so, please list:

Will you successfully promote your title by making (3) appearances per month?

How did you learn of the Christian U.S.A. Pageant?

Signature:

  Date:

Legal Guardian Signature: (if under 18)

  Date: