1. Last Name:
2. First Name:
3. Middle Initial:
4. Street:
5. City:
6. State:
7. Zipcode:
8. Email Address:
9. Home Phone Number:
10. Alternative Phone number you can be reached at:
11. Mother's Name:
12. Father's Name:
13. Current Grade:	11th Junior 12th Senior
14. Year to Graduate:	2010 2011
15. Name of High School attending (enter 'Home School' if appropriate)
16. School Phone Number:
17. School Street Address:
18. School City:
19. School State:
20. School Zipcode:
21. Guidance Counselor Name:
22. Have you ever had a sibling enrolled in the past at Liberty University?	Yes No
23. If yes, who?
24. Tell us about your church activities:
25. Tell us about your extracurricular activities:
26. Please share briefly your personal relationship with Christ.
27. In 250 words or so, describe a personal accomplishment you are most proud of and why.
28. The late Dr. Falwell believed everyone shoud have a BHAG or a big, hairy, audacious goal (a goal so big with out God you would fail), share with us in 250 words or so what your BHAG is.
29. Write a sample commerical for your - Why you should be selected to win the Grand Prize.
30. Below list up to 10 names and phone numbers for a 'call team.' A call team member is a friend or relative who will isten for your name in the Roll Call portion, and can call on your behalf. For more information on 'call team' read the Rules and Regulations.
31. Team Member #1:
32. Team Member #1 Phone Number:
33. Team Member #2:
34. Team Member #2 Phone Number:
35. Team Member #3:
36. Team Member #3 Phone Number:
37. Team Member #4:
38. Team Member #4 Phone Number:
39. Team Member #5:
40. Team Member #5 Phone Number:
41. Team Member #6:
42. Team Member #6 Phone Number:
43. Team Member #7:
44. Team Member #7 Phone Number:
45. Team Member #8:
46. Team Member #8 Phone Number:
47. Team Member #9:
48. Team Member #9 Phone Number:
49. Team Member #10:
50. Team Member #10 Phone Number: