18Under18Honoree

The Dinner Table Documentary

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Congratulations! We Are So Excited To Honor You.

Please Fill Out This Award Acceptance Form No Later than Sunday, March 4th, 2018 at 11:59 PM.

* Indicates required field

Name *

First

Last

Age *

are you currently able to attend the awards ceremony on April 18th at 6:00 PM? *

Yes No I'm Not Sure But Can Confirm Soon

WOULD YOU LIKE TO RECEIVE PERSONALIZED AWARD CEREMONY INVITATIONS TO SEND TO YOUR FAMILY AND FRIENDS? *

Yes No

Name of Current School/Academic Institution *

Name of School Dean or (if in college) Head of the Department for Your Major *

NAME OF SCHOOL GUIDANCE COUNSELOR OR (IF IN COLLEGE) ACADEMIC ADVISOR *

I'm currently a *

High School Freshmen High School Sophomore High School Junior High School Senior College Freshmen

Please List Any Extracurricular Activities You're Currently Involved In (this includes activities at your school, church or any social organizations you belong to. Example: Girl Scouts, Girls Inc, Pathfinders, etc *

Do you currently hold any leadership positions? Tell us about them! *

Do you currently have internship or part time job? (If yes, please tell us where, if no place write N/A) *

If you listed a place of employment for the previous question, what's the name of your manager? If you answered N/A please skip this question. *

Would you be interested in The Dinner Table helping you find an internship based on your interest? *

Yes No

Tell us about some of your career goals (feel free to share your plan to achieve them if you have one) *

The Dinner Table's Theme for This Year is "Overcoming My Obstacles" would you mind sharing with us a tough situation/or obstacle you've had to overcome? *

To-date what's your proudest achievement? *

Would you be interested in participating in an on-camera interview about your award for a local news station? *

Yes No Maybe, I'd need more information

Would you be available to attend any special events we host in your honor prior to the awards ceremony? (You May Choose More than one option) *

Yes, Monday Evenings Work Best Yes, Tuesday Evenings Work Best Yes, Wednesday Evenings Work Best Yes, Thursdays Evenings Best Yes, Friday Evenings Work Best Yes, Saturday Afternoon/Evenings Work Best Yes, Sunday Afternoon/Evenings Work Best Sorry, none of the times above work for me.

Lastly, Are you currently looking for a mentor? *

Yes No I already have one, but I wouldn't mind having another

Email *

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Congratulations! We Are So Excited To Honor You.​Please Fill Out This Award Acceptance Form No Later than Sunday, March 4th, 2018 at 11:59 PM.

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Congratulations! We Are So Excited To Honor You.

Please Fill Out This Award Acceptance Form No Later than Sunday, March 4th, 2018 at 11:59 PM.