Delegate Application Form

The titles of Miss Blackhawk Valley and Miss Blackhawk Valley's Teen are OPEN

The titles of Miss Moline and Miss Moline's Teen are CLOSED to the 309/861 and 815/779 area codes

Full Name*

First NameMiddle NameLast Name

Are you competing for Miss or Teen?

MissTeen

Local Competition Title you are competing for

Miss Moline or Miss Blackhawk Valley

Birth Date

Date

Age

Delegate's E-mail

example@example.com

Delegate's Phone Number*

Delegate's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent(s) Name(s)

Parent(s) Phone Number(s)

Parent(s) Email

School or College/University

Student Status/Grade

Freshman, Sophomore, Junior, Senior, Graduate, etc.

Major/ Minor/ What are you studying?

Year Graduated if applicable and Major/Minor/Degree obtained

Current job or career

Scholastic Ambition

Career Ambition

Are you claiming eligibility to compete via residence, work, or school?

ResidenceWorkSchool

Please further explain your eligibility based on your answer to the above question:

**See contract or delegate agreement and information below for detailed eligibility information

Talent type/title

Talent music

Yes I will be using musicNo I will not be using music

Title of Talent music/song if using (90 seconds or less)

Talent Introduction (used for stage production)

Ex: She's been singing since the age of 5, here is "blank blank" performing her rendition to "blank."

Community Service Initiative (CSI) Title

Brief explanation of CSI

This brief information regarding your CSI here will help us when we put together the competition script.

Have you competed in the Miss America Opportunity before?

YesNo

If yes, when and at what level?

Do you have any relatives who have served as a volunteer, judge, or other official with the Miss America Organization?

YesNo

If yes, please list the relation, position, and last date they were involved with MAO

I confirm to the following:

I am a US CitizenI am femaleI qualify based on eligibility requirements for the open vs closed titleI verify I meet the age requirements for the Teen/ Miss titleI am single and have never been marriedI do NOT have any dependentsI qualify based on school/residency/work requirements as outlined by Miss America

Have you signed up and registered to compete for Miss Blackhawk Valley with Miss America via the link below?

YesNo

Have you registered for a membership with Miss America and paid your annual $49.99 fee? This is mandatory in order to compete for both Miss and Teen. This will come from Miss America with links to complete this once the above local registration is complete.

YesNo

I understand I am required to raise a minimum of $30 for the American Heart Association via spot fund per Miss America rules and have successfully registered for a Spot Fund Account. The link for a spot fund account will also be sent from MAO.

YesNo

I understand the Miss Blackhawk Valley Organization has a $100 fee in order to compete for both Miss and Teen titles.

YesNo

I understand Miss America requires delegates to purchase and wear Rebel Athletics Red Miss America line for Health and Fitness.

YesNo

I acknowledge and have THOROUGHLY read the "Preparation Information Guide" document for the Miss and Teen BHV/Moline competitions.

YesNo

Signature

MISS AMERICA ELIGIBILITY REQUIREMENTS:

· Be a United States citizen

· Be a female

· Single (never been married)

· No legal dependents

· Age Eligibility:

Miss America: Delegates must be no older than 28 years of age as of September 30, 2026 and no younger than 18 on September 1, 2026.
Miss America’s Teen: Delegates must be no younger than 14 as of September 1, 2026 OR no older than 18 on September 30, 2026.

· Residency:

Delegates qualifying by residence must provide proof of at least 120 consecutive days of residency within the state prior to the date of competition.

· Employment:

Delegates qualifying by employment must submit documentation of full-time, in-person employment (minimum of 40 hours per week) held for at least 120 consecutive days prior to competition.

· Student Status:

Delegates qualifying through student status must be enrolled full-time at an accredited college or university located in the state. Full-time status is determined by the institution.

REGISTERING FOR MISS BLACKHAWK VALLEY LOCAL WITH MISS AMERICA (SHOULD BE DONE FIRST:

CLICK HERE FOR AN OVERVIEW VIDEO ON REGISTERING FOR OUR LOCAL VIA MISS AMERICA

CLICK HERE TO REGISTER TO COMPETE FOR OUR LOCAL WITH MISS AMERICA

ADDITIONAL INFORMATION:

- Once you have successfully registered to compete for our local pageant using the links above, Miss America will then send you an email to register for a Miss America Club Membership, which is $49.99.

- Spotfund links for fundraising for the American Heart Association will be given to you by Miss America via email once the membership is successfully completed. Each delegate is required to raise $30 PER LOCAL for the AHA.

- Each delegate will also pay a $100 entry fee to Miss Blackhawk Valley in order to compete. This may be paid in cash, check, or venmo (@MissBHVOrg). Checks will be made payable to the Miss Blackhawk Valley Scholarship Program.

Miss and Teen Delegate Application: