Northwestern Oklahoma State University



CERTIFICATION OF LOCAL WINNER

DIRECTIONS: This Certification of Local Winner form must be completed by the High School Principal or Superintendent of the contestant’s school. Each high school may enter one senior girl who will carry the school’s name in the Northwestern Homecoming Association’s Miss Cinderella Pageant. Please refer to pageant rules for additional details. This form must be returned by Wednesday, September 6, 2017---Ms. Lisa Franz, Miss Cinderella Pageant, NWOSU—Upward Bound, 709 Oklahoma Blvd., Alva, OK 73717.

FULL NAME OF CONTESTANT

NAME OF SCHOOL

SCHOOL ADDRESS

AGE/DATE OF BIRTH

CONTESTANT’S ADDRESS

(Where mail should be sent) City State Zip

CONTESTANT’S EMAIL ___________________________________________________________________

PHONE

(Area Code) School Home Cell

PARENT OR LEGAL GUARDIAN

NAME

ADDRESS

City State Zip

PHONE

Home Business Cell

TALENT PRESENTATION Give complete name of music and brief description of talent act. Please indicate if a CD or accompanist will be utilized during the talent presentation.

I do hereby certify that the contestant listed above will represent our school in the Miss Cinderella Pageant.

PRINTED NAME __________________________________________________

SIGNATURE ______________________________________________________

High School Principal or Superintendent

SCHOOL E-MAIL__________________________________________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download