Appointed Representative Program Application

Welcome to the Appointed Representative Program Application. If you plan to compete in the upcoming National Pageant, May 1, 2024 is the deadline to have your application submitted for the state queen’s title. We will continue to accept applications after May 1st for any remaining state or city titles still available.

If you have any questions please email Tiffany Reilly at appointed@theiampowerhouse.com

If you are under 18 years old, please have a parent or guardian register for you.

You will need to submit the following to complete this form:

Answer the questions on this form
Upload Resume
Upload Photo
Upload Personal Introduction Video Link
Pay Non-Refundable $50.00 Registration Fee

*IMPORTANT* All of these steps must be completed in order for your application to be processed. If any of the steps is not completed you will have to re-submit this form at a later date.

Step 1 of 5

Contestant's Name:*
First Last
State you are applying to represent:*
Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Best Phone Number For Contact:*
Parent's Cell Phone:
Contestant's Cell Phone:
Contestant's Birth Date:*
MM slash DD slash YYYY
Age as of January 1st:*
How old was the contestant on Jan 1st
Parent or Guardian Name:
First Last
Additional Parent or Guardian Name:
First Last
Email:*

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Education Level Last Completed in School:*
Last Grade Point Average:*
Answers below may include information pertaining to the last 3 years.
School/Work Activities:*
Name of organization/cause you donated your time to.*
Total Hours that you have served on this project without receiving compensation*
Name of Organization's Contact Person (the person whom you contacted)*

This would be whoever was your contact at the organization. If your project is one of your own creation, then you should have an adult onboard who oversees your efforts. Yes, the adult can be your parent or guardian.
Community Activities:*
Brief Service Description Please use the space below to give a brief description of the community service in which you were/are involved. Please use at least 3 words but not more than 100 words
Community Activities Full Description*
Full Service Description Please use the space below to tell us a more complete description, explaining and expanding upon your community involvement project. Please use at least 50 words, but no more than a maximum of 150 words for Princess and Jr. Pre-Teen age divisions. For Preteen – Miss divisions a minimum of 100 words maximum of 200 words.
Letter of Confirmation*
Max. file size: 32 MB.
Letter of Confirmation Scan your letter of confirmation and upload in the field below. This is a letter from the organization in which you served. It might be written by, for example, your contact person at the organization. Typically, it is on the organization's letterhead, but it does not have to be. Sometimes organizations write one of these to you as a "thank you" for your service. Or it may just be a one line note. It can contain extra information, and/or a message from the organization, but the primary purpose for this item is to confirm your service. If you have more than one letter, then combine them into one file which you will then upload
Honors and Awards:*
Life Ambitions:*
Please list any NAM state titles that you have held. If you have never held a NAM state title, write the word "none" in the space below.*

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Acknowledgements:
By answering "I Agree" to each of the following statements and clicking the "Submit" button below you acknowledge the following:
I acknowledge that all answers submitted are true and correct.*
I acknowledge that I am applying for a State Queens title, to represent my state, because my state doesn’t have a physical pageant for my age division.*
I acknowledge that if awarded a State Queen or City Queens title I will be financially responsible for all fees that are assigned to this title. I will make all deadlines or communicate to ARP coordinator if extension is needed.*
I acknowledge that if financial responsibilities aren’t made in a timely manner or arrangements haven’t been made then I might be subject to relinquishing my title.*
I understand that the National Yearbook deadline and all materials I want to be included in the National Yearbook must be in the pageant office at least three weeks prior to the first day of this year's National pageant. This includes photos, sponsor names, Spotlight Contest pages, and the payments associated with these items.*
I understand that I am responsible for my own travel and lodging reservations and any expenses at the pageant. If I earned and chose the National Trip through the Spotlight Contest, then I will receive the appropriate reimbursement based on the award. (Please see the National Guidebook for more information.)*
I understand that I may complete Spotlight Contest pages for the Yearbook to earn prizes such as hotel room nights (contestant must make their own reservation), sponsorship fees to the National All-American Queen’s competition, entry into the major optional contests, a trip to the national pageant, the National Ambassador Title, National Cover Girl Title, the National Cover Model Title, the National Cover Miss Title, and more!*
The contestant named on this form must reside or go to school in the state she represents, and she must participate in her correct age group. Neither the contestant, nor any of her immediate family members are employed by National American Miss, Inc. or National American Miss. In consideration for being accepted as a contestant in the national pageant activities, we, the parents and/or guardians of the contestant, do hereby release National American Miss, Inc., National American Miss, its staff, directors, subsidiaries, parent companies, assignees, employees, and volunteers from any and all claims and damages directly or indirectly resulting from named contestant participating in the National American Miss events; and we give permission to National American Miss, Inc. and National American Miss to use the contestant’s photographs, speeches, Community Service entries, testimonials, videos, etc., for publicity purposes and future material in printed, video, and/or internet form. It is agreed and understood that any scholarships, prizes, or college allowances that are part of the state and national programs are provided by the named sponsor, school, business, agency, or college, and that National American Miss, Inc. and National American Miss shall have no liability in regard to such scholarships, prizes, or college allowances. It is understood that all state and national pageant fees are non-refundable without exception. Contestant must not be or have ever been married.*
Contestant's Electronic Signature:
Date
MM slash DD slash YYYY
Parent or Guardian's Electronic Signature:
Date
MM slash DD slash YYYY
2022 Appointed Represented Deadlines
April 15th: Application submission deadline to be guaranteed a chance at the state queen title. April 15th to October 5th: Application submission deadline for all remaining state and city titles still available. No ARP applications will be accepted after October 5, 2022. May 15th: All ARP results submitted prior to April 15, 2022 deadline will be announced. August 1st: Deadline to order your crown and banner so that it arrives at your home prior to nationals. You must complete the crown and banner order form at www.namiss.com/banner and select “Group A: Appointed State Queen or Appointed City Queen”. June 20th: Final day to receive early bird discount for your custom ASHLEYlauren Opening Number Dress at www.NAMnationals.com. Sept 1st: Deadline to order your crown and banner so that it is available to pick up at your pageant check-in. You must complete the crown and banner order form at www.namiss.com/banner and select “Group A: Appointed State Queen or Appointed City Queen”.

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Registration Fee*
Price:
Total
$0.00
Credit Card

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Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

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COVID-19 Waiver

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Appointed Representative Program Application

Step 1 of 5

Acknowledgements:

2022 Appointed Represented Deadlines