Teen of the Week Submission

*First Name:	*Last Name:

*Parents’ Names* (Enter N/A if not applicable):
Mom First Name:	Mom Last Name:
Dad First Name:	Dad Last Name:

*Your Email:

*Age:
*Birthday: (dd/mm/yyyy) //

*GPA:

*Street Address:
*City:

State: Zip:

*Your Phone: (111–222-3333)
*School:

School Activities

*Freshman: (Enter N/A if not applicable)
*Sophomore: (Enter N/A if not applicable)
*Junior: (Enter N/A if not applicable)
*Senior: (Enter N/A if not applicable)
*Community Activities, Awards, Employment: (Enter N/A if not applicable)
*Education and/or career goals: (Enter N/A if not applicable)

*On a separate sheet, please write two essays not to exceed 350 words each on:
Describe examples that show your involvement in the community. Describe examples that showcase your leadership abilities.

Mail To:
Delaware Gazette 18 E. William Street Delaware, OH 43015 ATTN: Liz Robertson Subject: Teen of the Week Submission