Delegate Application Form

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

Full Name

First NameMiddle NameLast Name

Are you competing for Miss or Teen?

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

Format: (000) 000-0000.

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?

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

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?

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?

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

I confirm to the following:

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

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. COMPLETE THIS FIRST**

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.

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

I understand Miss America requires delegates to purchase and wear Rebel Athletics Red Miss America line for Health and Fitness. These Rebel items cannot be altered or bedazzled in any way. They must be worn as is.

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

Signature

MISS AMERICA ELIGIBILITY REQUIREMENTS:

· Be a United States citizen

· Be a female

· Single (never been married)

· No legal dependents

· Age Eligibility:

Miss 18-28: must be NO OLDER than 28 on September 30, 2027, and no younger than 18 on Sept 1, 2027.
Teen 14-18: must be no YOUNGER than 14 by September 1, 2027 and no older than 18 on Sept 30, 2027.

· 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 AND PAYING F0R AN ANNUAL CLUB AMERICA MEMBERSHIP SHOULD BE DONE FIRST, THEN REGISTER FOR OUR LOCAL WITH THE STATE AND MISS AMERICA.

LINKS ARE BELOW:

CLUB AMERICA: https://www.club.missamerica.org/ma-membership

MISS ILLINOIS LOCAL REGISTRATION: https://form.jotform.com/231911013124136

ADDITIONAL INFORMATION:

- 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: