Teen - Delegate Program Book Questionnaire

Teen Delegate Program Book Questionnaire
This document is meant to provide content for your Miss Illinois Teen Program Book Page. Please fill out all the questions below to the best of your ability. Note: Your responses will be written VERBATIM. Any grammatical or spelling errors will NOT be edited, so please take your time in filling out this questionnaire, as this will be distributed to contestants, families and judges.
Local Executive Director (LED)*
LED E-mail*
LED Cell Phone Number*

Area CodePhone Number
Local Title*
Delegate Name (As it is to appear in the Miss Illinois Program Book) *
Hometown (with State)*
Talent Selection*
Talent Type*
Social Impact Initiative *
How do you prefer to be contacted?
Select your direct contact preference *

Cell PhoneEmailBoth
Delegate E-mail*
Contestant Cell Phone Number*

Area CodePhone Number
Age*
High School Graduation Year*
Current School Attended*
Dream College to Attend*
Anticiapated College Major*
Scholastic Ambition*
Scholastic Honors*
Greatest Non-Academic Achievement*
What is your favorite?
Music Style*
TV Program*
Actor*
Actress*
Place to Visit*
Weekend Activity*
Way to spend the day*
Food*
Sport*
Sports Team*
Gadget*
Wardrobe Accessory*
Please answer the following questions in two sentences or less.
Who is the most influential person in your life?*
Tell us about one person who inspires you.*
How would you describe your own personality?*
What is one thing about you people may not immediately realize?*
Of what personal accomplishment are you most proud?*
What is one important thing you have learned from being in the Miss America Teen Program?*
If you are crowned Miss Illinois Teen, what do you want to accomplish during your Year of Service?*
Secret wish or dream?*
You're motivated by:*
Is there a personal connection to your platform?*
To what school organizations/clubs do you belong?*
Something interesting about your family:*
One thing you'd like to try that is out of character for you:*
What kind of hobbies do you enjoy? *
Social Media Networking

Please check your favorite social media and networking sites.
Check Favorite Social Media Sites*

FacebookTwitterInstagramPinterestLinkedInSnapChatYouTubeOther
If Other, Please List
Please add your social media handles you are using personally and to promote your local title.
Facebook(s)*
Twitter(s)*
Instagram(s)*
SnapChat(s)*
Others*
Please fill out this form completely prior to submitting. Thank you.
Once submitted, these responses may not be changed!
Form Submitted By:*
Title*
E-mail*
Phone Number*

Area CodePhone Number
Date Submitted*

MonthDayYear
Should be Empty:

Teen Delegate Program Book Questionnaire