Mississippi Boys State 2023

2023 Application

Complete this application to be considered for program admission.
Applicant's Information
Applicant Name*

First NameMiddle NameLast NameSuffix
Preferred Name*
Date of Birth*

MonthDayYear
Applicant Email*

Confirmation Emailexample@example.com
Applicant Cell Phone*
Cell Phone Number
T-Shirt Size*
Please upload a recent headshot below for Identification purposes:

Applicant's Academic Information
Will you be a high school senior as of August 2023?*

YesNo
GPA*
ACT Score*
High School Name*
High School Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
High School Principal Name*

First NameLast Name
High School Principal Email*
example@example.com
Guidance Counselor Name*

First NameLast Name
Guidance Counselor Email*

Confirmation Emailexample@example.com
Guidance Counselor Phone*
Cell Phone Number

Parents' Information

Parent/Guardian 1
Parent/Guardian 1*

First NameLast Name
Relationship to Child*
Parent/Guardian 1 - Email*

Confirmation Emailexample@example.com
Cell Phone*
Cell Phone Number
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parents' Information

Parent/Guardian 2
Parent/Guardian 2

First NameLast Name
Relationship to Child
Parent/Guardian 2 -Email

Confirmation Emailexample@example.com
Cell Phone
Cell Phone Number
Home Address Same as Parent/Guardian 1?

Yes
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact

Your Emergency Contact can not be one of your listed Parents/Guardians and must be 18 years of age or older. This contact will only be used in an emergency situation where neither Parents/Guardians are reachable.
Emergency Contact Name*

First NameLast Name
Relationship to Child*
Cell Phone*
Please enter a valid phone number.

Applicant Background

This portion should be completed by the applicant.
What extracurricular activities do you participate in at school or in the community?*
What honors or awards have you received during your high school career?*
How did you learn about the Boys State program?*

Acknowledgment of Cost

This portion is an acknowledgment that you understand the cost requirement to attend Boys State and the options that are available should payment be a concern.
The cost to attend Mississippi American Legion Boys State is $275. This payment covers the cost of meals, housing, and programming for the week. Payment will not be due until May 20th, 2023 and should not be sent until you have received notice of approval.

Cost should never prevent a student from attending our program. There are many resources available in each community that can help you get to Boys State. Your first option is to contact a nearby American Legion Post and ask if they have any scholarships available for you. Please review the "Cost" page on our website for a link to a listing of Mississippi's American Legion Posts.

Once again, cost should never prevent a student from attending our program. Should you need more assistance, please contact us at info@msboysstate.com.

Code of Conduct

This portion is an acknowledgment of our Code of Conduct and should be read by both the applicant and a parent/guardian.
DELEGATE WILL CONDUCT HIMSELF IN A MANNER BECOMING A GENTLEMAN

NO PARTICIPANT SHALL APPROPRIATE FOR HIS PERSONAL USE, DEFACE, OR DESTROY THE PROPERTY OF THE UNIVERSITY OF MISSISSIPPI, AMERICAN LEGION BOYS STATE, OR THAT OF ANY OTHER DELEGATE.

NO DELEGATE SHALL BE OFFENSIVELY BOISTEROUS OR ROWDY IN HIS PERSONAL CONDUCT DURING MEETINGS, IN THE DORMITORIES, ON THE GROUNDS OR DURING TRIPS CONDUCTED AWAY FROM CAMPUS. NOR SHALL LEWD OR OBSCENE LANGUAGE BE USED, OR SHALL DELEGATES POSSESS PORNOGRAPHIC LITERATURE, MUSIC OR PICTURES.

NO DELEGATE SHALL LEAVE THE UNIVERSITY OF MISSISSIPPI CAMPUS WITHOUT PROPER AUTHORIZATION OF THE DIRECTOR.

NO DELEGATE SHALL HAVE IN HIS POSSESSION FIREARMS, EXPLOSIVES, FIREWORKS, ILLEGAL DRUGS, NON-PRESCRIPTION DRUGS OF ANY FORM, OR ALCOHOLIC BEVERAGES AT ANY TIME.

NO DELEGATE WILL BE ALLOWED TO LEAVE BOYS STATE UNTIL THE FORMAL CLOSING OF THE SESSION ON SATURDAY, JUNE 3RD, 2023.

ANY VIOLATION OF THESE RULES OF CONDUCT WILL SUBJECT THE OFFENDER TO DISMISSAL. UPON DISMISSAL, LETTERS INDICATING THE REASON FOR DISMISSAL WILL BE SENT TO PARENTS, SPONSORS, AND SCHOOL OFFICIALS. ANY MATTER PERTAINING TO BAIL AND/OR ARREST SHALL BE ADDRESSED TO THE LAFAYETTE COUNTY SHERIFF AND/OR LAFAYETTE COUNTY JUSTICE COURT AND NOT WITH BOYS STATE. IN THE CASE OF A DISMISSAL, THE OFFENDER IS RESPONSIBLE TO REIMBURSE HIS SPONSOR OF HIS EXPENSES IN FULL.

I UNDERSTAND THAT I AM HONOR BOUND TO REPORT ANY VIOLATIONS OF THESE STANDARD RULES OF CONDUCT.

THE DIRECTOR MAY EXPEL OR TURN OVER TO LAW ENFORCEMENT ANY DELEGATE FOUND TO BE OR SUSPECTED TO BE IN VIOLATION OF STANDARD RULES OF CONDUCT.

I UNDERSTAND AND HEREBY AGREE TO THE TERMS SET FORTH AS THE RULES OF CONDUCT AND FURTHER AGREE THAT I WILL ABIDE BY SAID RULES DURING MY PARTICIPATION IN THE AMERICAN LEGION BOYS STATE.

THERE SHALL BE ABSOLUTELY NO APPEAL FROM THE DECISION OF THE DIRECTOR IN ANY MATTERS PERTAINING TO THE CONTINUING ELIGIBILITY OF A DELEGATE TO REMAIN AT BOYS STATE

Thank you for your interest in attending the 2023 session of American Legion Boys State!
Once you submit your application below, please allow us time to review your submission. Someone from our staff will be in touch with you regarding your acceptance at a later date. Should you have any questions, please email us at info@msboysstate.com.
Please verify that you are human*
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2023 Application

Applicant's Information

Applicant's Academic Information

Parents' Information

Parents' Information

Emergency Contact

Applicant Background

Acknowledgment of Cost

Code of Conduct

Thank you for your interest in attending the 2023 session of American Legion Boys State!