Honorary Page Program Form - House Of Representatives

Honorary Page Program Form - House Of Representatives - 2017

2017 House of Representatives

Honorary Page Program

Student Name: _____________________________________________________________

Address: _________________________________ City: ________________Zip:_________

Home Phone: _____________________

Age: _________ Grade: ____________

School Name: __________________________________ City: ________________________

Activities, Interests, Clubs, Organizations: ________________________________________

_________________________________________________________________________

Parent(s)/Guardian Name: ____________________________________________________

Daytime Phone: _____________________

Evening Phone: ______________________

Cell Phone: _____________________ E-mail: ____________________________________

Emergency Contact: Name: ___________________________________________________

Relationship: __________________

Phone: ___________________

Dates preferred for Capitol Visit: [Monday-Thursday in odd-numbered years; Monday-Friday

in even-numbered years.]

Choice: ___________ 2

Choice: ___________ 3

Choice: ____________

Please carefully check your school calendar, family calendar, and athletic/activity

schedules as the page spots fill quickly and changes to your day might not be possible

to accommodate.

Sponsoring (your local) Representative: __________________________________________

If you are not sure who your state representative is, go to the Oregon Legislature website to

find the link . . .

Required:

Include with your application, a separate written or typed statement addressing why

you are interested in becoming an honorary page for the Oregon House of

Representatives. Include in your statement what two things you would like to learn

from your experience as an honorary page for the House.

Honorary Page Program Form - House Of Representatives - 2017