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:
Applicant's Full Name *
Applicant's Full Name
Date of Birth *
Date of Birth
Home Address *
Home Address
Phone *
Phone
Parent/Guardian Name *
Parent/Guardian Name
Address (if different from above)
Address (if different from above)
Parent's Phone *
Parent's Phone
(You music MUST be registered with BMI/ASCAP/SESAC please check those sites before submitting)
Which local(s) did applicant compete in during 2019?
Check all that apply
Title Request *
You may select up to two (2) The state pageant reserves the right to make the final determination of titles based on specific branding needs. and obligations.
Date Application Completed *
Date Application Completed

PAYMENT INSTRUCTIONS

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.


Payment 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. ALL PAYMENTS ARE NON-REFUNDABLE

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