Participant Profile Form

Foundation for Delta Educational and Economic Development

Participant Profile Form

Final Form Due: December January 24, 2021

Participant

First Name

Middle Name

Last Name

Suffix

(Area Code)Mobile Number

Parent/Guardian

First Name

Last Name

Relationship

(Area Code)Mobile Phone

First Name

Last Name

Relationship

(Area Code)Mobile Phone

How should your parents’/guardians’ name appear in the Souvenir Journal? (Check One)

Mr. John and Mrs. Jane Doe
Mr. John Doe and Mrs. Jane Doe

Other

List Family Members that are past Cotillion Participants

1. First Name

Last Name

Relationship

Cotillion Year

2. First Name

Last Name

Relationship

Cotillion Year

3. First Name

Last Name

Relationship

Cotillion Year

4. First Name

Last Name

Relationship

Cotillion Year

5. First Name

Last Name

Relationship

Cotillion Year

What high school do you currently attend?

List your top 5 activities, clubs, teams, sports, honors or awards that you have received or participated in throughout high school and the number of years.

Number of Years

List your top 5 church activities, involvement, ministries, etc. that you have participated in and the number of years you were involved.

Number of Years

List your top 5 community service activities and the number of years you have been involved.

Number of Years

What church do you currently attend?

Type a formal paragraph about your goals, include the college you plan to attend, your major(s) and your future career.

Type a formal paragraph about your most Memorable Moment (Positive) and explain why it was so memorable. Include what you learned from it.

What is your favorite quote or motto that you chose to live by? Include the author, if applicable.