The Mattie Pearl
Personal Data Form
PLEASE PRINT ALL INFORMATION
Name________________________________________________________
Address______________________________________________________
City, State, Zip__________________________________________________
Home Phone____________________________
Cell Phone________________
Email:________________________________________________________
Grade Level:____________ GPA______
School Name___________________
Parents Name___________________________________________________
Church______________________________
Phone_____________________
District Field Rep________________________________________________
Ministry Involvement: (Give a brief description of your active involvement)
Local church___________________________________________________
District_______________________________________________________
Jurisdiction____________________________________________________
Community____________________________________________________
Favorite Scripture________________________________________________
Name of Most influential person and why________________________________
What talent will you display at the Pageant?______________________________
_____________________________
PARENTS SIGNATURE & DATE
____________________________
DISTRICT REP SIGNATURE & DATE
