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__________________________________________________
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