At Large Application.jpg

All fields are required. Please upload all required documents below (Copy of Birth Certificate, Proof of Residency in Oregon, Copy of Health Insurance Card).

Once you have submitted your application, you will be notified via email regarding additional forms and documentation.

Checkbox *
I fully read and agree to the rules & qualifications in the following documents:
Application Information
Applicants Full Name *
Applicants Full Name
Date of Birth *
Date of Birth
Home Address *
Home Address
Phone *
Parent/Guardian Information
Parent/Guardian Name *
Parent/Guardian Name
Address (if different from above)
Address (if different from above)
Phone *
School Information
Competition Info
(Music must be registered with BMI/ASCAP)
Title based on your county/region of residency. However, the State program reserves the right to assign a title of their choosing based on applicable branding techniques.
Date of Completion *
Date of Completion
Upload Documents
Please describe documents you are sending, i.e. Copy of Birth Certificate, Proof of Residency in Oregon, Copy of Health Insurance Card, etc. (Please re-name all files to include your name before uploading to ensure your files are bundled correctly. Ex: smith-jane-birth certificate)


At Large Application/Registration Fee: $795.00

or by check...

Please make checks payable to: Miss Oregon Scholarship Program

Mail to: Jann Leeper P.O. Box 99, Midland, OR 97634

***Please retain a copy of your receipt for personal records and include a copy in your Contestant binder.

Non-refundable payments and ALL required additional program and production paperwork must be received within two weeks from your approved application email you receive. Your official sash will not be ordered without a completed application and fee paid in full.

*Otherwise, your title will be released and you will have to submit another application.