MISS ROME’s OUTSTANDING TEEN
	
	APPLICATION and FACT SHEET

FULL NAME: ___________________________________________

HOME ADDRESS: _______________________________________________

TELEPHONE: (HOME)___________________(SCHOOL)_____________________
E-MAIL ADDRESS__________________________________________
PARENT'S NAME______________________________________
HIGH SCHOOL OR MIDDLE SCHOOL  _________________________

DATE OF BIRTH:______________________________

TYPE OF TALENT_______________________________
               (dance, vocal, etc.) 

YEAR OF GRADUATION:______________