2020 BYA

DEBUTANTE REGISTRATION FORM

PERSONAL INFORMATION
Name (Last, First, Middle):	*
Address :	*
City	*
State:	*
County:	*
ZIP:	*
Cell Number:	*
Email Address:	*
Date of Birth (MM/DD/YYYY)	*
Age	*

PARENT/GUARDIAN INFORMATION
Mother's Name:
Address :
City:
State:
County:	*
ZIP:
Primary Home Telephone:
Cell Number:
Email Address:

Father's Name:
Address :
City:
State:
County:	*
ZIP:
Primary Home Telephone:
Cell Number:
Email Address:

BIOGRAPHICAL INFORMATION
Name of High School:	*
Grade :	*
Anticipated graduation date:	*
Plan to Attend College:		Yes No
List Academic Activities and Involvement (Clubs, Organizations, Sports, Leadership, Etc.):
List Community Involvement (Church or Place of Worship, Public Service Projects, Community or Civic Organizations, Etc.)
Awards and Honors (Academic and Community)
Hobbies and Interests:
What are your goals after high school?
How did you hear about the BYA Debutante Program? (Please check all that apply)	*	BYAA Website Facebook Mail Church Announcement Past Debutante Other
Other (Please specify):

SIGNATURES REQUIRED

Parents, please indicate that you understand the following statements:
I give permission for my child to be photographed and for her photo to be used in promotional material.	*	Yes No
I have transportation to and from all workshops, practices, and events.	*	Yes No
Do you have a Marshal? If yes, please provide your Marshal’s name and phone number.	*	Yes No
Marshall's Name and Phone Number:
What is your t-shirt size:		Sm Med Lg XL XXL
I understand that my attendance and participation at workshops, practices, and events will provide a valuable experience. If I desire to withdraw my participation as a 2020 BYA Debutante Program, I must do so in writing to the Black Youth In Action Debutante Corporation by June 20, 2020.	*	Yes No
APPLICANT:
Name:	*
Date:	*
PARENT:
Name:	*
Date:	*

EMERGENCY CONTACT INFORMATION: Person to be notified in the event of an emergency.
Name:	*
Relationship to Applicant:	*
Home Telephone:	*
Cell Telephone Number:	*
Do you have any allergies (i.e., food?)	*	No Yes
If yes, please list your allergies:

REQUIRED ATTACHEMENTS:
Non-refundable Application Fee:	*	$25.00
Print-ready Photo Headshot.	*
In a 1-page summary, describe what you hope to gain by participating in the 2020 BYA Debutante Program.	*
Provide two (2) letters of recommendation. Letters of recommendation can obtained from a teacher, member of your church or a community service coordinator. 1st Letter upload:	*
2nd Letter of recommendation	*
Debutante-Parent Commitment Form	*

INTERVIEW: Saturday, April 18, 2020.
If your application is selected, you will be invited to an interview. You will be notified by Monday, April 14, 2020 for your 20-30 minute interview on Saturday, April 18, 2020. We ask that you come prepared and properly dressed for an interview.
Completed applications and required attachments are due no later than Friday, April 10, 2020. All incomplete and late received applications will be rejected with no further action taken for considerations by the BYA Debutante Corporation. Completed applications and corresponding documents can be e-mailed to byaorg1978@gmail.com or mailed to: Black Youth in Action Debutante Corporation, Debutante Program, P.O. Box 604, Aberdeen, MD 21001
PARENT COMMITMENT FORM:
I/we (parent/parents) give our daughter/son permission to participate in the Black Youth in Action Debutante Program. I/we acknowledge that a portion of the program is raising money in the form of fundraising, advertisements, donations, and/or ticket sales. I/we understand that if my daughter/son misses 3 workshops and/or ball practices she/he may be asked to withdraw from the program with no option to return until the following year. Additionally, I understand that any monies that we have provided the Black Youth in Action Debutante Program towards stipends, ticket sales, etc., may be forfeited and integrated into the program. I/we acknowledge commitment to the program and by checking off the (Yes) box below agree to the terms of the program.
	*	Yes
DEBUTANTE COMMITMENT FORM:
I (Debutante) acknowledge my commitment to the Black Youth in Action Debutante Program. I acknowledge that a portion of the program is raising money in the form of fundraising, advertisements, donations, and/or ticket sales. I understand that if I miss 3 workshops and/or ball practices I may be asked to withdraw from the program with no option to return until the following year. Additionally, I understand that any monies that I have provided the Black Youth in Action Debutante Program towards stipends, ticket sales, etc., may be forfeited and integrated into the program. I acknowledge commitment to the program and by checking off the (Yes) box below agree to the terms of the program.
	*	Yes
Total	*