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Competition Application

High school students of African-American descent, who are citizens or legal residents of the United States, and are enrolled in high school (grades 9-12) are eligible to apply.

Please fill out the information below.

Name: *

Last Name, First Name MI

Student Address: *

City: *

State:

School Zip Code: *

Zip Code: *

E-mail: *

Home Phone: *

xxx-xxx-xxxx

Cell Phone: *

xxx-xxx-xxxx

Date of Birth: *

Gender: *

Male

Female

Grade: *

US Citizen or Legal Resident: *

Yes

Competition Year: *

School: *

School Address: *

School City: *

School State:

Parent Name: *

Last Name, First Name MI

Parent Street Address: *

Parent City: *

Parent State: *

Parent Zip Code: *

Parent Home Phone: *

xxx-xxx-xxxx

Parent Cell Phone: *

xxx-xxx-xxxx

Parent E-mail: *

Mentor/Coach Information: *

Mentor

Coach

You need to have a teacher or coach working with you in your competition area.

Mentor/Coach Name:

Contact:

Phone number and/or email.

NAACP membership is required.
Are you a NAACP member?
ACT-SO is a major youth initiative of the National Association for the Advancement of Colored People (NAACP). Participants will be expected to take a youth membership in the NAACP. Click here to join the NAACP.

NAACP Membership: *

Yes

NAACP Youth Council:

Yes

Are you a NAACP Youth Council member?

Parent Authorization: *

By placing my initials in this field I acknowledge that I allow my child to fill out this form and I authorize my child to participate in the NAACP-Westchester Region ACT-SO competitions.

Student Information:

School Information:

Parent Information:

Choose up to three categories.

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