Miss Black USA - Scholarship Pageant

If you meet the eligibility requirements and there is not a state pageant held in your state, you may apply online as an At-Large Delegate. To apply, complete and submit the online application, upload a recent photo and pay your $50.00 non-refundable application fee.

ALL FIELDS WITH * MUST BE FILLED OUT OR YOUR REQUEST WILL NOT BE PROCESSED.

Miss Black USA Online Application

Name:	Date of Birth:
Street Address:
City:	State: Zip:
Home Phone:
Message Phone:
Email:
I wish to apply to represent:
I certify that I in this state.

Pageants Previously Entered (Titles, if any):
School or University:
Employer:
Education level and all degrees received:
GPA:
Parent or Guardian if under 18:
Are you currently under any contracts at the present?
If you selected "Yes" above, please explain:
What is your platform?
What is your talent/talents?
How did you hear about this pageant?

I authorize the verification of the information provided on this form. I certify that I am a single (unmarried) female, was born female gender, between the ages of 17 and 27, and I am eligible to compete for the title of Miss Black USA Pageant. You must be 17 and no older than 27 by the date of competition, July 15, 2009. Note: Your online application will not be processed without payment of the $50 non-refundable application fee.
Print Name:	Date:
Print Signature: