Professional Documents
Culture Documents
Participant Application
Sponsored by Zeta Phi Beta Sorority, Incorporated
Tau Phi Zeta Chapter
Canton, Mississippi
An unofficial high school transcript, two (2) letters of recommendation must accompany all applications, 2.5 grade
point average and a nonrefundable $35 money order. At least one recommendation should be from an academic
official. Deadline for submission of these items is January 18, 2012.
Participant Information:
Name: ______________________________________________________ Telephone: _______________________
First
Middle
Last
Mailing Address:
_____________________________________________________________________________________________
Street
City
State
Zip
Parents Information:
Mother: ______________________________________________________ Telephone: ______________________
(Area Code)
Number
City
State
Zip
Number
Number
City
State
Zip
Number
Education:
High School: _______________________________________________________
Address: _____________________________________________________________________________________
Street
City
GPA: ______
State
Zip
2012 Blutillion
Participant Application
Community Involvement:
Extra Curricular Activities: _______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Recognitions: _________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
____________________________
Applicants Signature
Date
_____________________________________________
Parent/Guardian Signature
___________________________________
Date
2012 Blutillion
Participant Application
Essay
Briefly tell us about yourself, describing future goals, ambitions, interests, and etc
2012 Blutillion
Participant Application
Sports Contact
Church Contact
School Contact
Work Contact
Volunteer Contact
2012 Blutillion
Participant Application
Sports Contact
Church Contact
School Contact
Work Contact
Volunteer Contact
2012 Blutillion
Participant Application
Personal Reference Form
to be completed by January 18, 2012
Participants Name: ______________________________________________
1. What is your relationship with the participant? _____________________________________________________
2. How long have you known the participant? ___________________________
3. Please circle for each characteristic:
a) Character and
personality
Poor
Fair
Good
Excellent
Outstanding
b) Initiative and
drive
Poor
Fair
Good
Excellent
Outstanding
c) Interaction with
others
Poor
Fair
Good
Excellent
Outstanding
d) Leadership
demonstrated
Poor
Fair
Good
Excellent
Outstanding
e) Concern for
others
Poor
Fair
Good
Excellent
Outstanding
f) Team Player
Poor
Fair
Good
Excellent
Outstanding
How do you think the participant will benefit from participating in the Blutillion?
Additional comments:
Thank you for your time and effort. Be assured that the information you supply will be kept in the strictest
confidence. Please return this form by January 18th.
If you have any questions, please call Dina Smith, (601) 750-3940.
2012 Blutillion
Participant Application
Personal Reference Form
to be completed by January 18, 2012
Participants Name: ______________________________________________
1. What is your relationship with the participant? _____________________________________________________
2. How long have you known the participant? ___________________________
3. Please circle for each characteristic:
a) Character and
personality
Poor
Fair
Good
Excellent
Outstanding
b) Initiative and
drive
Poor
Fair
Good
Excellent
Outstanding
c) Interaction with
others
Poor
Fair
Good
Excellent
Outstanding
d) Leadership
demonstrated
Poor
Fair
Good
Excellent
Outstanding
e) Concern for
others
Poor
Fair
Good
Excellent
Outstanding
f) Team Player
Poor
Fair
Good
Excellent
Outstanding
How do you think the participant will benefit from participating in the Blutillion?
Additional comments:
Thank you for your time and effort. Be assured that the information you supply will be kept in the strictest
confidence. Please return this form by January 18th.
If you have any questions, please call Dina Smith, (601) 750-3940.