Class of 2027 Young Americans Student Form

Congratulations on your nomination as one of the Greater Susquehanna Valley’s outstanding Young Americans!

Please take a few moments to complete the following:

• Keep your responses brief. Your answers may be published in The Daily Item, so if you have a long list of achievements, please select the ones you would most like to be recognized for.
• Include your photo with your submission. Be sure to name the file using your first initial and last name (e.g., sjones.jpg).
• Submit all materials by the stated deadline. We cannot guarantee inclusion in the publication if materials are received late.

If you have any questions, please contact Natalie Fox at 412-710-6915 | natalie@positiveripplescoaching.com.

We’re proud to celebrate your accomplishments and look forward to sharing your story with the community!

Student Name

First Name *

Last Name *

Student Email (not school issued) *

Parent/Guardian Name (1)

First Name *

Last Name *

Parent/Guardian Name (2)

First Name

Last Name

Parent Email *

Home Address

Address Line 1 *

Address Line 2

City *

Zip/Postal Code *

Unique Talents or Hobbies *

Leadership Positions Held (i.e., Student Council, Team Captain, etc.) *

Special Achievements or Awards *

Community Service or Ways You Have Given Back *

Future Plans (i.e., College, Join Workforce, Stay in the Valley, etc.) *

What qualities do believe led to you being selected as a Young American? *

What is something you would like people to know about you? *

Student Photo

Class of 2027 Young Americans Student Form

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