Berks County's Outstanding Young Woman - Preliminary Questionaire
Name _________________________________________________________________________
Address _______________________________________________________________________
City, State, Zip __________________________________________________________________
School ________________________________________________________________________
Parents _______________________________________________________________________
E-mail ________________________________________________________________________
Date of Birth ______/______/______ Telephone # (______) ______________________________
Activities and Clubs ______________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
College or school you wish to attend__________________________________________________
______________________________________________________________________________
Career you have chosen and why?____________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
What does the Outstanding Young Woman Program mean to you?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Talent(s) and training in talent ______________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Notes:
Please type or print.
Please use
another sheet of paper for more room not back side of this sheet
Computer printouts must be dark enough to photocopy well.
Use Ink, if handwritten.
Please send this application to:
Norman Adam
351 High Road
Kutztown, Pa 19530
Attn: BCOYW