2025 COTILLION APPLICATION FORM

PARTICIPANT INFORMATION
Participant Name*

First NameMiddle NameLast Name
Gender*

FemaleMale
Birth Date

MonthDayYear
Enter birth date in MM-DD-YYYY format
Mailing Address*

Street Address

Street Address Line 2 or P.O. Box

CityState / Province

Postal / Zip Code
Home Phone (including area code)*
Please enter a valid home phone number with area code
Mobile Phone (including area code)*
Please enter a valid cell phone number with area code
Email*
example@example.com
SSN (Last four digits) *
Last 4 digits ONLY
High School*
High School Cumulative GPA*

PARENT/GUARDIAN INFORMATION
Mother/Guardian Name*

First NameLast Name
Mother's Phone Number (cell preferred)*
Please enter a valid phone number with area code.
Mother's Email*
example@example.com
Father/Guardian Name*

First NameLast Name
Father's Phone Number (cell preferred)*
Please enter a valid phone number with area code.
Father's Email*
example@example.com

PRESENTER AND WALTZ PARTNER INFORMATION
Female Presenter is Mother/Guardian named in Parents/Guardian Section and will also serve as participant's Waltz Partner (if applicable):*

YESNO
Male Presenter is Father/Guardian named in Parents/Guardian Section and will serve as participant's Waltz Partner (if applicable):*

YESNO
Alternate Presenter First and Last Name and Relationship (if applicable)

Presenter First and Last NamePresenter Relationship to Participant
Alternate Presenter Phone Number (if applicable)
Please enter a valid phone number including area code
Alternate Presenter Email (if applicable)
example@example.com
NOTE: Waltz Partner MUST be 21 years of age or older.
Waltz Partner First and Last Name and Relationship (if applicable)

Waltz Partner First and Last NameWaltz Partner Relationship to Participant
Waltz Partner Phone Number (if applicable)
Please enter a valid phone number including area code
Waltz Partner Email (if applicable)
example@example.com

UPLOAD REQUIRED DOCUMENTS
Cotillion applicants must provide the following documents with the Cotillion application:
- Official High School Transcript
- Two (2) signed letters of recommendation.(NOTE: One must be from a teacher or academic official.).
- Headshot Photograph
UPLOAD DOCUMENTS HERE:*

pdf, doc, docx, jpg, jpeg, png
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FINAL STEP - FIRST PAYMENT DUE WITH APPLICATION!!!
FEMALE PARTICIPANT FEE - An inital payment of $300 must be submitted with this application.

MALE PARTICIPANT FEE - An inital payment of $225 must be submitted with this application.
Cotillion Fee Payment Amount ($300-female or $225-male)*

prevnext( X )
USDWrite in the dollar amount of your payment above: $300 for female participants or $225 for male participants. In the notes section within PayPal, please include participant's name.

Pay with PayPal

First Name

Last Name

Credit Card Number

Security Code

Card Expiration

Please click one of the PayPal options to complete payment and submit the form.

2025 COTILLION ONLINE APPLICATION