Optomist Teen of the Month Application

OPTIMIST “TEEN OF THE MONTH” NOMINATION 

Name:                                                                         Age:

Address:                                                                     School:

                                                                                    Class:

                                                                                    GPA:

Phone:

School Activities (Junior and Senior High):

Special Honors (Junior and Senior High):

Community Service:

Hobbies and Interests:

Employment Record:

Future Goals:

Advice to Fellow Students:

Return to:       Optimist Club of Steamboat Springs

                        c/o “Teen of the Month/Year” Committee

                        P. O. Box 880725

                        Steamboat Springs, CO  80488

Fax: 871-7344                                    Email: robmac@ticus.com or kburch@springsips.com or

                                                                        adellacroce@mountainvalleybanking.com

                        (Use back of page for additional information)

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