The Congressional Award

The Congressional Award
Online Registration Form

* First Name:

* Last Name:

* Street Address:

* City:

* State:

* Zip Code:

* Phone:

Email Address:

* Date of Birth: (mm/dd/yy)

* Gender:

Male Female

Congressional District:

Member of Congress:

Sponsoring Agency: (if applicable)

Name of School:

* Advisor's Name:

Advisor's Street Address:

Advisor's City:

Advisor's State:

Advisor's Zip Code:

* Advisor's Phone:

Advisor's Email Address:

Have you previously been involved in The Congressional Award Program? Yes No

If so, did you earn an award? Yes No

The Congressional Award Foundation works with various partnering organizations to provide additional opportunities to Congressional Award participants. These partners are listed on our website: http://www.congressionalaward.org/congress/org/partners.htm.

If you are interested in receiving information regarding the volunteer opportunities, expeditions, scholarships and other youth programs offered by our partners, please check this box to authorize us to share your personal information with these organizations.

* These fields are required