National Miss Juneteenth Scholarship Program

1. NAME (print)______________________________________________________

2. ADDRESS_________________________________________________________

3. PHONE NUMBER__________________________________________________

4. EMAIL ADDRESS__________________________________________________

5. DIRECTOR’S NAME________________________________________________

6. DIRECTOR’S PHONE NUMBER_____________________________________

7. QUEEN’S TITLE / STATE___________________________________________

8. I am 18 years old YES___ NO___

9. PARENT/GUARDIAN NAME/NUMBER______________________________

10. BACKSTAGE CHAPERONE 11.NAME/NUMBER__________________________________________________
 

Queen must be biologically born female.

Queen must be a beneficiary of the 13th Amendment. 

Queen will be required to perform 20 hours of community service and a minimum 1500-word essay about Juneteenth or Juneteenth related topic.
 

Queen will be subject to a $300 registration fee and $500 minimum in ad sales. 

The Queen must never have, nor will she during her reign, pose for any photography, video, or film associated with any nudity or pornography. Nor has she ever or is presently involved any form of employment that involves partial or complete nudity. 

Any Queen and/or family member or guest, showing less that sportsman like behavior will lead to disqualification of the Queen, with no refund under these circumstances.

I, ___________________________________________agree all decisions of judges at the National level are final and irrevocable, and I will abide by all regulations at the National competition. 

Queen will permit National Miss Juneteenth Program, NJOF and their licensees the right to use contestant’s photograph for publicity purposes in connection with all NJOF and/or NMJSP related programs. 

Queen will permit National Miss Juneteenth Program and their licensees to televise live or by the use of film or videotape any portion or all of the competition.
 

Queen understands if selected as National Miss Juneteenth, as National/International Ambassador for Juneteenth Queen is subject to speaking engagements, special appearances and to abide by all rules and regulations required by same or forfeit title. 

Queen understands that as National Miss Juneteenth, for one year her professional affairs will be under the sole management of National Miss Juneteenth Program and/or their licensees and that she will not give any written or oral endorsements commercially without the expressed permission of NMJSP.
 

Queen further acknowledges that all rights for any appearances, endorsements, speaking engagements, acting roles, etc. resulting from National coronation shall belong exclusively to same. 

I, _________________________________ agree to all the rules and regulations stated on the application
 

Parent/Guardian signature ______________________________________________