Name (Preferred) *
Please enter your preferred name. This will be what we use when emailing you or on your award materials.
* State/Territory * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AS GU MP PR VI AA AE AP
Please be sure to enter you address correctly, this is what we use to mail you your awards! Only addresses in one of the U.S. States or Territories.
* Phone * Email * Date of Birth *
Please only register if you are at least 13 1/2 years of age AND not yet had your 24th birthday. We cannot accept registrations outside this age range!
MM slash DD slash YYYY
Required for registrants under the age of 18. Optional for adults.
Gender does not influence eligibility. We collect demographic information for the sole purpose of reporting (grants, yearly reports to Congress, etc.). If the participant is uncomfortable reporting this information, they may choose "Identify as other/Prefer not to report."
Race and/or ethnicity in no way influence eligibility. We collect demographic information for the sole purpose of reporting (grants, yearly reports to Congress, etc.). If the participant is uncomfortable reporting this information, they may choose "Unknown/Prefer not to report."
Select One Unknown/Prefer not to report American Indian or Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander Hispanic or Latino or Spanish Origin of any race White Two or more races Military Youth * Partnering Organization
We work with a variety of (inter)national and local youth organizations. If you have an affiliation with any of our official partners or would like to list one of your own, please let us know. Note: You DO NOT need a partnering organization to register for The Congressional Award.
Select the one that best applies N/A (No Affiliation) 4-H Boston Education - Los Angeles Boy Scouts of America CAG Safe Study Abroad DiscoveryBound Fort Worth Independent School District Girl Scouts of the USA Growing Leaders HOBY Hunter Science High School Lion's Heart Magdaleno Leadership Institute Military Family Advisory Network (MFAN) NCCC FEMA NCCC Traditional People to People International Project Next Special Olympics St. Louis Irish Arts State Council U.S. Air Force U.S. Army U.S. Coast Guard U.S. Marine Corps U.S. Navy U.S. Senate Page School (Washington, DC) Youth Service America Other (List Organization Below) Other Partnering Organization * AmeriCorps Campus * -Select Campus- North Central Region (Iowa) Pacific Region (California) Southern Region (Mississippi) Southwest Region (Colorado) Current School Advisor's Name *
You must choose an Advisor who will serve as your mentor for The Congressional Award. This can be anyone BESIDES your parents, relatives, or peers.
* Advisor State * AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AS GU MP PR VI AA AE AP
* Advisor's Email * Advisor's Phone How did you hear about The Congressional Award? * -Select- Congressional Award Participant / Alumni Congressional Award Website Congressional Office Family / Friend I Don't Quit Tour (IDQ - Mateo Magdaleno) Internet / Search Engine School Social Media Word of Mouth Youth / Service Organization Other Please Describe
Provide details of the organization, media, or entity that referred you to The Congressional Award. This helps us reach more young people.
Waiver and Agreement * I agree to the following Congressional Award ("Program") rules and requirements:
• I will select the activities I will perform in order to earn a certificate or medal.
• I will not attempt to perform any activity until I have made certain that I can perform it safely.
• No one is authorized by the Program to: (i) advise as to the safety of any activity or as to whether I am prepared to perform it safely, or (ii) supervise or exercise any control or authority over me or any other participant.
• I hereby release and hold harmless each of the individuals and legal entities involved in the Program from any and all liability of any kind for any injury I might suffer while performing any activity in connection with the Program.
• Information about me and my participation in the Program may be publicized by the Program.
• This agreement shall remain in effect as long as I am participating in the Program. Participant Signature *
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(Required for participants not considered adults under state law, generally those under 18 years old). I am a parent or legal guardian of The Congressional Award participant listed above. We have read the foregoing Waiver and Agreement and agree on behalf of ourselves and the participant to the terms thereof. We will assure ourselves that the participant is aware of the risk involved in each activity and we take full responsibility in lieu of the Program for each activity.
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Are you unable to pay the registration fee and/or qualify for the Federal Free/Reduced Lunch program through your school? * File *
If you are unable to pay the $25 registration fee, please attach documentation showing your financial need. Example: documentation of your eligibility for Free/Reduced Lunch.
Registration Fee *