MISS LUZERNE COUNTY S OUTSTANDING TEEN / MISS NORTHEASTERN PA S OUTSTANDING TEEN / MISS WILKES-BARRE/SCRANTON S OUTSTANDING TEEN SCHOLARSHIP PAGEANT

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1 2016 NEPA SCHOLARSHIP MISS LUZERNE COUNTY S OUTSTANDING TEEN / MISS NORTHEASTERN PA S OUTSTANDING TEEN / SCHOLARSHIP PAGEANT Dear Prospective Teen Contestant: NEPA S OFFICIAL PRELIMINARY TO MISS PA OUTSTANDING TEEN, AND THE OFFICIAL MISS AMERICA TEEN PROGRAM We are pleased that you are considering entering the 2016 Miss Luzerne County s Outstanding Teen, Miss Northeastern PA s Outstanding Teen, and Miss Wilkes-Barre/Scranton s Outstanding Teen Scholarship Pageant, to be held Sunday, October 25, 2015 at Mohegan Sun, Plains, PA. This is the official Miss America Scholarship Pageant s sister Teen Program. This program is for young ladies years of age. Please note that if you are 17 and a senior you are not eligible for the Teen Program but are eligible for the Miss Program. For all the details on eligibility requirements, please visit the Teen section of our website. This is a scholarship competition, with scoring as follows: Private Interview 35% Evening Wear & On-Stage Question 20% Talent 35% Lifestyle and Fitness -10% We are very proud of our current title holders, Courtney Richards & Madison Dompkosky. They look forward to crowning this years Miss Luzerne County s Outstanding Teen, Miss Northeastern PA s Outstanding Teen & Miss Wilkes-Barre/Scranton s Outstanding Teen. Fill out and mail the 2016 Teen Application form along with a copy of your birth certificate, proof of residency (state ID card or an official document that shows your address), a headshot photo (does not have to be the one you want used in the program) (These items are not returnable). Once we receive the above information, you will receive an confirmation from us that your items above have been received, and you are guaranteed a spot in the line-up. We will mail to you the local pageant agreement form and all other forms such as fact sheet, critical issue essay, talent form (include a copy of the CD you will use in your on stage talent presentation) and accident /medical form. Note that all the above items should be received preferably one month in advance of the event date. Official deadlines will be posted on the nepapageant.com website. 588 KASKO ROAD, SHAVERTOWN, PA

2 You may also check the Northeastern PA Pageant Association website at There is an entry fee of $100, and it is approved and supported by the Miss Outstanding Teen Program. The NEPA events are produced by the NEPA Scholarship Pageant Association, Inc., a PA state not-for-profit organization. Once you have completed your forms, please mail them along with your entrance fee to: NEPA Scholarship Pageant Association, Inc. 588 Kasko Road Shavertown, PA Any questions should be ed to: The winner of Miss Luzerne County s Outstanding Teen, Miss Northeastern PA s Outstanding Teen and Miss Wilkes-Barre/ Scranton Outstanding Teen will compete in the Miss PA s Outstanding Teen finals in June, Her state entrance fees will be underwritten by the NEPA Scholarship Pageant Association, along with competition needs from its kind sponsors. If you would like to enter, but are new to all this, please note that the NEPA event will hold rehearsals on Sunday morning October 25, We will rehearse opening number, on-stage walking/modeling, plus help with hair and makeup. We will hold a short orientation Saturday evening, October 24, 2015 (Time TBA). Should you have questions concerning the scholarship pageant, how to enter, or about the program itself please feel free to Remember to get your application in as quickly as possible to ensure your spot in the NEPA Pageant! Sincerely, Dawn Cinti, Teen Director Charles Kasko, Executive Director NEPA Scholarship Pageant Association, Inc. 588 KASKO ROAD, SHAVERTOWN, PA

3 NEPA SCHOLARSHIP 2016 APPLICATION FORM MISS LUZERNE COUNTY S OUTSTANDING TEEN / MISS NORTHEASTERN PA S OUTSTANDING TEEN / SCHOLARSHIP PAGEANT Please complete and mail immediately to hold your spot! Full Name Age Date of Birth Home Address City, State & Zip Phone # Addresses STATISTICS Hair Color Eye Color Height EDUCATION High School Year Graduated EMPLOYMENT Employer s Name & Address Title Date of Hire TALENT PRESENTATION Please indicate type of talent and, if known, song title and type of musical background NEPA Scholarship Pageant 2016 Application, Page 1 of 2

4 SPECIAL TRAINING IN TALENT Please list any training you have had in music, drama, dancing, voice, art, etc INTERESTING FACTS Please list any interesting facts for publicity PARENTS Please list the first and last names and hometowns of your parents Are you a citizen of the United States? Yes No Are you a female and born a female? Yes No Your Social Security Number Signature Parent or Guardian s Signature Parent or Guardian s All data must be factual. The failure to provide factual information may result in your disqualification from the pageant. You will be required to furnish a photo copy of your birth certificate and a photo ID with date of birth and residency clearly shown. These copies may be returned with this application or at the latest, one month prior to the pageant. Mail application, $100 Entry Fee, photo ID with residency or birth certificate copy as soon as possible to hold your spot to: NEPA Scholarship Pageants, 588 Kasko Road, Shavertown PA If possible, if you are new to this program, please submit a recent photograph. You may submit another photo for the Program Book, if you wish. This application will NOT go to the judges. This form need not be typewritten. It may be completed in ink. Include the FACT SHEET and CRITICAL ESSAY with your application if they are ready. These two forms must be typewritten to specifications. TO BE ACCEPTED INTO THE PAGEANT, THOSE APPLICATIONS FROM THE CONTESTANTS DATED EARLIEST WILL BE ACCEPTED AND THOSE FROM CONTESTANTS DATED LATER WILL BE PLACED ON A WAITING LIST if far too many applications are received. Mail your application first to hold a spot, but then follow with THE FACT SHEET AND CRITICAL ISSUE ESSAY to be considered a contestant. You will hear from us if too many have applied and you are on a wait list. ALL ADDITIONAL PAPERWORK AND VERIFICATIONS MUST BE RECEIVED IN A TIMELY MANNER. NEPA Scholarship Pageant 2016 Application, Page 2 of KASKO ROAD, SHAVERTOWN, PA

5 2016 NEPA SCHOLARSHIP PLEASE REMEMBER MISS LUZERNE COUNTY S OUTSTANDING TEEN / MISS NORTHEASTERN PA S OUTSTANDING TEEN/ TYPING THE CRITICAL ISSUE ESSAY This ONE (1) page, single-spaced document combined with the Contestant s Resume, will comprise your entire application for this job. The judge s will receive exactly what is submitted. Any items submitted that do not fit the established criteria will be returned for correction only once. Any items which do not meet the criteria or are submitted after the deadline will not be given to the judges. The contestant may explain the lack of judging materials during her interview, if she so chooses. The resume should include an explanation of what your chosen platform is, how you will promote it, and why it is important for the local pageant to embrace this platform. INSTRUCTIONS 1. Go to the word processing program of your computer. 2. Start a new document. 3. Set the margins for 1 on all four sides. The font style may not be any smaller than 10 and no larger than 12 point type using the Times New Roman font style only. 4. With the justification set to the far left, type Name: in bold. Following the colon (:), hit the space bar twice. Then, type your name. 5. Double space down. Set your justification to center. Then type in Bold and underline the title of your Platform. 6. Double space down. Write what you feel is critical for the judge s to know about your platform and why it is necessary for you to have the job of Miss Luzerne County s Outstanding Teen, Miss Northeastern PA s Outstanding Teen or Miss Wilkes-Barre/Scranton s Outstanding Teen to promote this issue. What you write will be what the judges know about your platform, your role in successfully dealing with this issue, and how the role of Miss Luzerne County s Outstanding Teen, Miss Northeastern PA s Outstanding Teen or Miss Wilkes-Barre/Scranton s Outstanding Teen may play in your plan. 7. The essay may include some of the following items (this is not meant as an exhaustive list): A clear definition of the platform and the specific issues you wish to address A plan of how you have or will create awareness of the platform The way in which you have or will change attitudes regarding this issue The way in which your platform issue will move the NEPA Scholarship Pageant forward. Your media plans Your marketing strategy How you propose to fund your ideas/plans Any significant accomplishments you have made in regard to your issue 8. At the bottom of the page you MUST set the justification to the right. Type a line of 26 spaces. Below that line, you must type Signature/Date. Once you have printed the document, you must sign and date this document.

6 2016 NEPA SCHOLARSHIP MISS LUZERNE COUNTY S OUTSTANDING TEEN / MISS NORTHEASTERN PA S OUTSTANDING TEEN / JUDGES FACT SHEET Full Name Title Hometown Age Date of Birth School Grade GPA TALENT PRESENTATION: Please indicate type of talent song title SPECIAL TRAINING IN TALENT: Please list any training you have had in music, drama, dancing, voice, art, etc HOBBIES & SPORTS: HONORS & AWARDS: INTERESTING FACTS: SCHOLASTIC/CAREER AMBITION: WHY I SHOULD BE MISS LUZERNE COUNTY S OUTSTANDING TEEN / MISS NORTHEASTERN PA S OUTSTANDING TEEN / 2016: PLATFORM Platform statement provided to judges Contract: I agree to allow my daughter to participate in the Miss Luzerne County s Outstanding Teen Pageant and the Miss Pennsylvania Outstanding Teen Pageant and Miss America s Outstanding Teen Pageant should she be chosen a local and/or state titleholder, and to abide by the decision of the judges, which is final. I further hold the pageant, judges, hostesses, committee members, owners of the facility where the pageant is conducted and all others involved in the production of the pageant harmless from any and all liability arising out of personal injury, property damage, or similar causes. Contestant Signature Date Parent Signature Date

7 2016 NEPA SCHOLARSHIP MISS LUZERNE COUNTY S OUTSTANDING TEEN / MISS NORTHEASTERN PA S OUTSTANDING TEEN / TEEN TALENT REGISTRATION FORM (ALL talent presentations must be timed at 90 seconds or less) FULL NAME TYPE OF TALENT: Singing, dancing, instrumental etc. MUSIC FULL TITLE OF MUSIC: TIMED AT: COMPOSER: PUBLISHER: WILL YOU USE A CUSTOM CD?: OR A COMMERCIAL CD?: *TWO Copies required, one must be mailed with talent form one month prior to event. READING, MONOLOGUE ETC. FULL TITLE PLAY, BOOK OR WRITING: COPYRIGHTED? AUTHOR: PUBLISHER: PROPS I WILL BRING THE FOLLOWING PROPS WHICH I WILL USE IN MY ACT: MICROPHONE REQUESTS: WIRELESS HANDHELD (IF AVAILABLE): OR MICROPHONE ON A STAND: SUGGESTED TALENT INTRODUCTION: *If you plan to perform Broadway show music in character you will have to obtain your own clearance with that show s producer. These clearances are extremely difficult, often impossible to get; therefore we strongly advise against their use. No talent will be performed on our stage that does not have the proper clearances.

8 Accident/Medial Release Form NEPA Scholarship Pageant Association, Inc. ALL OF OUR PAGEANT STAFF WILL BE TAKING EVERY PRECAUTION TO PREVENT IT, BUT THE POSSIBILITY EXISTS IN ANY COMPETITION OR ACTIVITY THAT AN ACCIDENT REQUIRING MEDICAL ATTENTION COULD OCCUR. THEREFORE, THE FOLLOWING IS TO BE SIGNED BY EACH CONTESTANT AND/OR PARENT. I/We will be responsible for all medical expenses for treatment (for the full year, if you are selected as the representative) required (but not limited to) any accident resulting from competing in all events leading up to and including the NEPA Scholarship Pageant Competition. I also grant permission to be transported to the nearest hospital should medical attention be necessary. I/we do hereby agree to indemnify and hold harmless, release and discharge the NEPA Scholarship Pageant Association, Inc. its agents, servants, volunteers, from any and all claims for personal injuries or property damage occurring to or sustained by the contestant while participating in pageant activities or in the act of being transported to and from said activity and including any and all consequential damage claims which I/we may be entitled to without regard to the negligence of the parties. I agree to follow the rules and regulations set by the NEPA Scholarship Pageant Association, Inc. representatives whether written or verbal. This agreement has been entered into freely, voluntarily and after a full opportunity for review by the undersigned. Contestant s Signature Date Parent/Guardian Signature Date MEDICAL RELEASE INFORMATION Parent/Guardian phone # Physician to be called in case of emergency Physician s Address: Physician s Phone # Medical information that may affect activities: (special dietary concerns, medications, conditions, etc.) In my absence should the need arise while she is participating in programs of the NEPA Scholarship Pageant Association, Inc., I hereby authorize, consent and direct the NEPA Scholarship Pageant Association, Inc., its directors and officers and any physician, hospital or other health care provider selected by the Organization to take such action as is necessary in the circumstances to provide emergency care and related treatment of the above named. I hereby designate the NEPA Scholarship Pageant Association, Inc., its directors and officers my authorized agent for the signing of consent forms required by such health care providers in connection with such health care. Health Insurance ID number Group # Plan # Name of health care insurance provider: DATE Signature of Parent/Guardian DATE Signature of Contestant 588 Kasko Road, Shavertown PA 18708:

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