Local Pageant Recap form

Please fill out the form completely and submit. Once you are finished, you will need to submit a second time if you held a Teen pageant.

Local Pageant:
Date Held:
Location:
Director:
Email:
Co-Director:
Email:

New Title Holder Information

Name:
Address:
City, State, Zip:
Phone:
Email:
Platform:
Talent:
School:
Year in school:
Father's Name:
Email:
Mother's Name:
Email:
Parents Address:
City, State, Zip
Parents phone:

Pageant Information

New Titleholder's Scholarship Amount:
TOTAL Cash Scholarships Awarded:
TOTAL In-Kind Scholarships Awarded:
In-Kind Donor Schools:
Total Number of Contestants:
CMNH Fundraising Total:
CMNH Hours Donated Total:
Personal Platform Fundraising Total:
Personal Platform Hours Donated Total:
Teen Entry Fee (if applicable):
Princess Entry Fee (if applicable):
Contestant Names:
Judges Names:

The following must be submitted to the Miss Indiana Pageant along with this recap
within 2 weeks of the local pageant:

1. Program Book (3 copies)
2. Judges Materials (ballots, tally sheets, both paper and electronic, affidavits)
3. For Sweeps, winner's and runners-up's fact sheets and platform statements
4. Contact Information Sheets for all contestants

Return to:
Terry Iden, Field Director
133N 900W
Kimmell, IN 46760