HIGH SCHOOL. Please type or print and complete all the fields below. You may also enter online at

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1 APPLICATION FORM Completed application forms submitted by mail must be postmarked by 10/26/18 and received by 10/31/18. Send completed application form via U.S. Mail to: Dreamers Contest Submission, P.O. Box 25138, West Bloomfield, MI or via overnight mail to: Dreamers Contest Submission, Telegraph Road, Suite 405, Southfield, MI Forms submitted by mail MUST be sent to either of these two addresses in order to be eligible. APPLICANT You must be between 13 and 19 years of age and enrolled in high school (grades 9 12) during the school year at an accredited school located within the 48 contiguous United States or District of Columbia at time of application. Please type or print and complete all the fields below. You may also enter online at First Name M.I. Last Name Street Address (No PO Boxes Please. Include Apt./Ste. if applicable.) City/State/ZIP Code Date of Birth: Month/Day/Year Phone Number Address Check One (optional) Male Female HIGH SCHOOL Name of School Grade Level School City/State/ZIP Code City/State/ZIP Code School Phone Number

2 By signing below I acknowledge that I have read and understand, and I have fully complied with, the Official Rules. I acknowledge that my completed Application Form and accompanying Essays will be in full compliance with the Official Rules. All information is true to the best of my knowledge and belief. I understand that if I am selected to attend Disney Dreamers Academy, I grant to SH Production Company, LLC and Disney Destinations, LLC, the sponsors of Disney Dreamers Academy Essay Contest (collectively, the Sponsor ), and their designees and representatives the right to use my name, address (city and state), photograph, videotape or any likeness of me, my Essays, and statements made by or attributed to me relating to Disney Dreamers Academy Essay Contest or Disney Dreamers Academy, for any lawful purpose, including, without limitation, advertising, publicity and other commercial purposes, in any and all forms and media, including without limitations, the Internet, throughout the world without further compensation, consultation or consent. I hereby assign all rights, title and interest, including and without limitation copyright rights to my completed Application Form and accompanying Essays, to the Sponsor. Applicant s Signature Month/Day/Year

3 SECTION A Parent/Legal Guardian (to be completed by parent/legal guardian of all Applicants) Parent/Legal Guardian s Printed Name Parent/Legal Guardian s Daytime Phone Number Street Address (No PO Boxes Please. Include Apt./Ste. if applicable.) City/State/ZIP Code Relationship to Applicant Phone Number Address OPT-IN (optional): Yes, I d like to receive occasional updates, special offers and other information from Disney Destinations, LLC and its affiliated and associated companies. By signing below I authorize my child/legal charge identified in this Application Form to enter Disney Dreamers Academy Essay Contest for an opportunity to be selected to attend Disney Dreamers Academy scheduled for 3/21/19 through 3/24/19 at Walt Disney World Resort near Orlando, Florida. I have read and understand, and I and my child/legal charge have fully complied with, the Official Rules. I have reviewed my child s/legal charge s completed Application Form and accompanying Essays in their entirety and agree that they are in full compliance with the Official Rules. All information is true to the best of my knowledge and belief. I understand that if my child/ legal charge is selected to attend Disney Dreamers Academy, I grant to SH Production Company, LLC and Disney Destinations, LLC, the sponsors of Disney Dreamers Academy Essay Contest (collectively, the Sponsor ), and their designees and representatives the right to use my and my child s/ legal charge s name, address (city and state), photograph, videotape or any likeness of me or my child/ legal charge, Essays, and statements made by or attributed to me or my child/legal charge relating to Disney Dreamers Academy Essay Contest or Disney Dreamers Academy, for any lawful purpose, including, without limitation, advertising, publicity and other commercial purposes, in any and all forms and media, including without limitations, the Internet, throughout the world without further compensation, consultation or consent. I, on behalf of my child/legal charge, hereby assign all rights, title and interest, including and without limitation copyright rights to my child s/legal charge s completed Application Form and accompanying Essays, to the Sponsor. Check one: Applicant is under 18 years of age Applicant is 18 years of age I agree to the above. Parent/Legal Guardian s Signature Month/Day/Year Parent/Legal Guardian s Address I acknowledge I am the parent/legal guardian of the Applicant above.

4 SECTION B Should be completed as directed below. Please answer the following questions in your own words. Be clear and concise character count for each essay question must not exceed 1200 characters, and character count for each rapid fire question must not exceed 140 characters. If additional space is needed, you may use an 8.5 x 11 sheet of paper, which must be securely stapled to this form. Be sure to include your full name and address on any additional sheet of attached paper. Rapid Fire Question 1 If you were given a phone/recording device and 24 hours, where would you go and what would you capture? Rapid Fire Question 2 Which title (movie or book) best describes you and why? Rapid Fire Question 3 How could the world be different because you have achieved your dream?

5 SECTION B (continued) Essay Question 1 What celebrity, community leader, or social media influencer inspires you and why?

6 SECTION B (continued) Essay Question 2 If you could impact one social issue, what would it be and why?

7 SECTION B (continued) Essay Question 3 What inspires your dream and what obstacles have been a challenge to achieving your dream? Completed Application Forms submitted by mail must be postmarked by 10/26/18 and received by 10/31/18. Send completed application form via U.S. Mail to: Dreamers Contest Submission, P.O. Box 25138, West Bloomfield, MI or via overnight mail to: Dreamers Contest Submission, Telegraph Road, Suite 405, Southfield, MI