Please complete the following form to apply to compete in the Miss UNC Pembroke Scholarship Pageant. Name Banner ID # Age Birth Date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015 Home Address Home Phone School Address School Phone Email Address Cell Phone Parent/Guardian's Name(s) Mother's Address Mother's Daytime Phone Father's Address Father's Daytime Phone EDUCATION Classification (year) Major Minor PAGEANT INFORMATION Pageant Experience (if any) Talent Title of Song/Music/Etc. Platform Issue Sponsors ACTIVITIES AND HONORS Hobbies High School Organizations High School Honors College Organizations College Honors List some interesting facts about yourself that might be used for publicity What is your future ambition and why? Why are you seeking the title of Miss UNC Pembroke? (250 words or less) By clicking the Submit button, I agree that all the above information is correct.