Senior Influencer Application
Spots are extremely LIMITED. Submit your application below & we will contact you with the next steps!
Name
*
First Name
Last Name
Email
*
example@example.com
Parent's Name
*
First Name
Last Name
Parent's Email
*
example@example.com
What high school do you attend?
*
Northern Lebanon
Cedar Crest
Lebanon
ELCO
Palmyra
Annville Cleona
Tulpehocken
Pine Grove
Hershey
Other
*If you chose other above, list the school here.
What year will you graduate?
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
Please enter a valid phone number.
List all your social media accounts (Instagram, Facebook, TikTok, etc):
*
Sports and/or school activities you are involved in
*
Other job commitments and/or important things to know
Who referred you?
Upload a recent pic or selfie of yourself
*
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