Please fill out and submit this form electronically, or you can download and print the form by clicking here.

Contact Information
Name:		Parent's Name:
Address:		Guardian’s Name:
BTU Account #:		Address:
Home Phone:		Home Phone:
Work Phone:		Work Phone:
E-Mail Address:		E-Mail Address:
Age:		Grade & Graduation Date	Sophomore Junior Senior
Academics/Activities
During which hours are you available for volunteer assignments?
School Attended:
Organizations:
Extra-curricular Activities:
Special Activites
In the space below please tell us what activities you are involved in.
Why would you make a great community Representative to Washington D.C.
In the space below, please tell us why you would like to go to Washington D.C.
Essay Topic:
If you would have only one electrical appliance to use, what would it be and why? Be descriptive as possible. Limit to 2 pages please!
Person to Notify in Case of Emergency
Name:		Relationship:
Street Address:
City State Zip Code	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Home Phone:		Work Phone:
Email Address:
Parent/ Legal Guardian and Student Affirmation
	We affirm that (1) all information provided on this application is correct, (2) the parent has given permission for the student to enter this contest and to participate in the Youth Tour should he/she win, (3) the Student agrees to participate in the Youth Tour on the scheduled dates should he/she win, and (4) the Student agrees to all conditions and rules set forth by BTU and to fully execute all obligations and responsibilities