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 2.0.10

First Name *
Last Name *
Mailing Address * (very important for reliable delivery)
City *
State *
Zip *
Their e-mail address
Their primary Phone (A/C)+###-####
Their High School *
In the 2009-2010 school year, this nominee will be .... *	a Junior - Boys State 2010 a Sophomore - Boys State 2011 a Freshman - Boys State 2012 an 8th Grader - Boys State 2013 a 7th Grader - Boys State 2014
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 ]