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Light The Night
Visionaries of the Year
Student Visionaries of the Year
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Participant
Preferred Pronouns (ex. he/she/they/other)
Candidate Name (as you would like it displayed on materials)
Email
Date of Birth
Date of Birth: Date
Home Phone Number
Cell Phone Number
Home Address
Home Address
Additional
City
State
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Postal Code
Additional Info
High School Graduation Year (e.g. 2026)
High School
Parent / Guardian(s) Name
Parent / Guardian(s) Number
Parent/Guardian(s) Employer
Parent / Guardian(s) Email Address
Essay Questions
Why are you interested in the Student Visionaries of the Year Program?
Provide highlights of extracurricular/volunteer activities you are involved in, or if you have ever held any leadership roles
Share your ideas of how you might engage your community, team and others in raising funds should you be selected as a candidate.
If you have a special connection to the mission which has inspired you to seek a nomination, please include that information.
How did you hear about Student Visionaries of the Year?
Add a Co-Participant
Co-Participant
Preferred Pronouns (ex. he/she/they/other)
Candidate Name (as you would like it displayed on materials)
Email
Date of Birth
Date of Birth: Date
Home Phone Number
Cell Phone Number
Home Address
Home Address
Additional
City
State
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Postal Code
Additional Info
High School Graduation Year (e.g. 2026)
High School
Parent / Guardian(s) Name
Parent / Guardian(s) Number
Parent/Guardian(s) Employer
Parent / Guardian(s) Email Address
Co-Participant Essay Questions
Why are you interested in the Student Visionaries of the Year Program?
Provide highlights of extracurricular/volunteer activities you are involved in, or if you have ever held any leadership roles
Share your ideas of how you might engage your community, team and others in raising funds should you be selected as a candidate.
If you have a special connection to the mission which has inspired you to seek a nomination, please include that information.
How did you hear about Student Visionaries of the Year?
Add a Second Co-Participant
Co-Participant 2
Preferred Pronouns (ex. he/she/they/other)
Candidate Name (as you would like it displayed on materials)
Email
Date of Birth
Date of Birth: Date
Home Phone Number
Cell Phone Number
Home Address
Home Address
Additional
City
State
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
Armed Forces (Canada, Europe, Africa, or Middle East)
Armed Forces Americas
Armed Forces Pacific
California
Colorado
Connecticut
Delaware
District of Columbia
Federate States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP Postal Code
Additional Info
High School Graduation Year (e.g. 2026)
High School
Parent / Guardian(s) Name
Parent / Guardian(s) Number
Parent/Guardian(s) Employer
Parent / Guardian(s) Email Address
Co-Participant 2 Essay Questions
Why are you interested in the Student Visionaries of the Year Program?
Provide highlights of extracurricular/volunteer activities you are involved in, or if you have ever held any leadership roles
Share your ideas of how you might engage your community, team and others in raising funds should you be selected as a candidate.
If you have a special connection to the mission which has inspired you to seek a nomination, please include that information.
How did you hear about Student Visionaries of the Year?
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