Please complete the following questions.

Requirements: Must be a junior male in high school in the top half of the class and
be involved in extracurricular activities in the school and community.
* Denotes a required field

    ver 2.0.08

First Name *
Last Name *
Mailing Address * (enter '?' if you don't know)
City *
State *
Zip *
E-Mail address *
Primary Phone * (A/C)+###-####
High School *
In the 2008-2009 school year, this nominee will be a .... *	Junior - Boys State 2009 Sophomore - Boys State 2010 Freshman - Boys State 2011 8th Grade - Boys State 2012 7th Grade - Boys State 2013
Why are you nominating this person to attend Boys State?
Your Name *
Your email or phone number, if we have questions.

---

Thank you for taking the time to complete this form! This form supported by www.oltec.net

[ www.ksbstate.org ]