Registration Application

July 1, 2024 - January 31, 2025

for the

2025 Miss Juneteenth America Scholarship Pageantry Program®

Registration Information

The registration fee is set at $450 for new participants and $350 for repeat participants. You can opt to pay in installments, but remember, the full amount must be settled by May 1, 2025—this is the final deadline to register!

This fee covers everything you need for an amazing experience, including workshops, activities, the reception, brunch, a stylish t-shirt, the Africatown tour, and a souvenir booklet. Just a quick note: lodging fees are not included in the registration fee, so if you decide to stay at our host hotel with our group rate, those costs will be your responsibility. Stay tuned for hotel rates, which will be announced soon!

A friendly reminder: the registration fee is non-refundable. To get your application rolling, please submit a $50 non-refundable application fee at the time of registration. This fee will go toward your total registration cost, and remember—there are no exceptions!

If you’re interested, partial scholarships may be available! For more information, feel free to reach out to us at info@missjuneteenth.org. We can’t wait to welcome you! 🌟

Parent/Guardian Acknowledgement

I have read and fully understand the Rules and Regulations, as well as the Roles and Responsibilities of the crowned Junior Miss Juneteenth America® and/or Teen Miss Juneteenth America® (whichever applies). I am excited to submit my child’s registration for the 2025 4th Annual Miss Juneteenth America Scholarship Pageantry Program™. I agree to follow all the rules, regulations, and guidelines set by The Maynard 4 Foundation, and I acknowledge that all fees are non-refundable.

I also give my consent for any and all video, photography, and media coverage during and after the program that relates to this event. Additionally, I permit The Maynard 4 Foundation to use my child’s name and images (and likeness) for informational, promotional, and any other professional purposes they deem appropriate, both before, during, and after the program. I understand that all content created for the Miss Juneteenth America Scholarship Pageantry Program™ will be the property of The Maynard 4 Foundation, and they will not need to seek approval for any images, videos, or photographs prior to their use.

Finally, I agree to hold The Maynard 4 Foundation harmless for any and all liability during my participation in the 2025 program and any related events as either a queen or participant of the Miss Juneteenth America Scholarship Pageantry Program™.

By typing your name below, you are acknowledging and agreeing to all of the terms as specified above.

Today's Date

Address

City

State

Zip Code

Your Phone Number

Email Address

Your Personal Social Media URL(s)

Participant's Full Name

Partcipant's Date of Birth

Participant's Address

Participant's City

Participant's State

Participant's Zip Code

Paticipant's Phone Number

Participant's Email Address

Participant's Social Media URL(s)

Participant's School Name

Participant's GPA

Participant's Grade Level

Participant's School Activities

Participant's Extracurricular Activities

Participant's Accomplishments

Participant's Community Service Activities

Participant's Hobbies/Talents

Participant's Career Aspirations Select one profession.

Select the State the Participant's Favorite HBCU is located?

Select Participant's Favorite HBCU in Alabama?

Select Participant's Favorite HBCU in Arkansas?

Select Participant's Favorite HBCU in California?

Select Participant's Favorite HBCU in Delaware?

Select Participant's Favorite HBCU in D.C.?

Select Participant's Favorite HBCU in Florida?

Select Participant's Favorite HBCU in Georgia?

Select Participant's Favorite HBCU in Illinois?

Select Participant's Favorite HBCU in Kentucky?

Select Participant's Favorite HBCU in Louisiana?

Select Participant's Favorite HBCU in Maryland?

Select Participant's Favorite HBCU in Michigan?

Select Participant's Favorite HBCU in Mississippi?

Select Participant's Favorite HBCU in Missouri?

Select Participant's Favorite HBCU in New York?

Select Participant's Favorite HBCU in North Carolina?

Select Participant's Favorite HBCU in Ohio?

Select Participant's Favorite HBCU in Oklahoma?

Select Participant's Favorite HBCU in Pennsylvania?

Select Participant's Favorite HBCU in South Carolina?

Select Participant's Favorite HBCU in Tennessee?

Select Participant's Favorite HBCU in Texas?

Select Participant's Favorite HBCU in Virgin Islands?

Select Participant's Favorite HBCU in Virginia?

Select Participant's Favorite HBCU in West Virginia?

Participant's Favorite Quote

Participant's Selected Historical Figure (Black Female) Black female from the United States that is an Unsung Hero not often discussed and/or as well known to the general public, but information is available via research, including a photo.

Participant's T-Shirt Size

Participant's Food Allergies

Explain with specificity how the participant plan to use the scholarship funds that you earn.

State the nonprofit (must have 501(c)(3) designation) of choice to receive a grant and provide their mission statement and/or website information.

I understand that the non-profit selected must be able to produce a Letter of Determination as provided by the IRS reflecting their 501(c)(3) status. I understand that the non-profit selected must be able to produce a Letter of Determination as provided by the IRS reflecting their 501(c)(3) status. Yes No

I understand that I must submit a headshot of the participant from the waist up wearing a solid colored blouse or dress on a solid white background. I understand that I must submit a headshot of the participant from the waist up wearing a solid colored blouse or dress on a solid white background. T-shirts, multi-colored blouses, low-cut tops, or selfies are not acceptable. Submit photo via email to our branding team at admin@ckiniodesign.com. Yes No

I understand that the information provided on this application will be used to create the participant's bio for event and marketing purposes. I understand that the information provided on this application will be used to create the participant's bio for event and marketing purposes. Yes No

I agree to pay the full registration fee of $450 (non-refundable) for new participants or $350 (non-refundable) for repeat participants no later than May 1, 2025? The application fee due at the time of submission is $50 (non-refundable), which will leave a balance of $300 or $400 unless paid in full at the time of submission. I agree to pay the full registration fee of $450 (non-refundable) for new participants or $350 (non-refundable) for repeat participants no later than May 1, 2025? The application fee due at the time of submission is $50 (non-refundable), which will leave a balance of $300 or $400 unless paid in full at the time of submission. Yes No

How did you hear about the Miss Juneteenth Scholarship Pageantry Program?

Financial Obligation

Registration costs $450, which is non-refundable and must be paid in full by May 1, 2025. When you submit your application, an application fee of $50 (also non-refundable) is required. If you pay this fee at the time of application, your remaining balance will be $400. If you choose to pay the entire amount upfront, you can do so at that time.

To help you manage payments, you will be set up for automatic monthly payments to ensure the full registration fee is received by the deadline.

Please note that all fees are non-refundable. After you submit your application, The Maynard 4 Foundation will send you an invoice for the $50 application fee. This fee must be paid when you submit your application; otherwise, it will be rejected.

Payments can be made via credit/debit card, cashier’s check, or money order. We do not accept cash. If you pay electronically, please be aware that you will be responsible for any transaction fees.

Make cashier check or money order payable to the following: The Maynard 4 Foundation

You may mail payment and any additional documents as needed to the following:

The Maynard 4 Foundation
200 U.S. Highway 98, Suite 4, #323
Daphne, Alabama 36526

Cash and personal checks are not accepted.

Registration Application

Registration Information

Parent/Guardian Acknowledgement

Financial Obligation

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