AMERICAN LEGION AUXILIARY
ALASKA GIRLS STATE
Debra Henderson, Director
P O Box 39768
Ninilchik, Ak 99639
(907) 252-3544

2009 APPLICATION DATE__________________

HIGH SCHOOL__________________________

NAME________________________________________________AGE____________

ADDRESS_______________________________________________________________ (street or box No.) (City) (Zip)

PHONE_________________________ Cell #: _____________________________

PARENT OR GUARDIAN__________________________ADDRESS__________________

ARE YOU A U.S. CITIZEN_______ ARE YOU A JUNIOR IN HIGH SCHOOL NOW___

TO WHAT HIGH SCHOOL ORGANIZATIONS HAVE YOU BELONGED? _________________

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OFFICES HELD IN THE ABOVE ORGANIZATIONS______________________________

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LIST OTHER ACTIVITIES THAT YOU PARTICIPATE IN OUTSIDE SCHOOL_________

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LIST HOBBIES AND/OR INTERESTS________________________________________

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CHURCH AFFILIATION OR PREFERENCE_____________________________________

HEALTH: HAVE YOU HAD MEDICAL TREATMENT IN THE LAST SIX MONTHS________ REASON_______________________________________________________________

DO YOU HAVE ALLERGIES? ___ASTHMA? __HEART AILMENT?__

SKIN DISEASE _____VEGETARIAN? _____ OTHER__________ EXPLAIN PROBLEMS ON BACK

GIVE 2 PERSONAL REFERENCES (NOT RELATIVES) PHONE # AND ADDRESS:

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SIGNATURE_____________________________ On back explain briefly why you wish to attend Girls State