Beautillion Interest Form

1

The Name of the Individual Completing this form* This field is required.

First Name

Last Name

2

Your Email* This field is required.

example@example.com

3

Your relationship to the Beautillion Program* This field is required.

I am recommending a Potential Participant (Beau or Jr. Beau)

I am interested in participating as a Beau or Junior Beau

I am unsure but would like to receive additional information

4

What is the current grade or age of the prospective participant?

11th grade

12th grade

College Freshman

5 years old (Junior Beau)

6 years old (Junior Beau)

7 years old (Junior Beau)

8 years old (Junior Beau)

Unsure/Unknown

5

Name of Prospective Participant

First Name

Last Name

6

What school does the prospective participant currently attend?

7

Please share any contact information you may have for the prospective participantPhone, Email Address, Social Media Handles, Mailing Address, etc.

8

Name(s) and contact information of the prospective participants parent(s), guardian(s), or caring adult(s)If unknown, please list "N/A" below

9

What is your current grade or age?

10

What school do you currently attend?

11

Your Phone Number

Please enter a valid phone number.

12

Name(s) and contact information of your parent(s), guardian(s), or caring adult(s)If unknown, please list "N/A" below

13

What is your affiliation?Please select all that apply

Community Member

Educator/Education-Adjacent (i.e. counselor, school leader, service provider)

Non-profit/Community Program

Religious Program

Potential Funder/Sponsor

Other

14

Any additional information you would like to provide