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SHICK
DIRECTOR
JAMES ALCORN
ASST. DIRECTOR
WILLIAM DENSON
ASST. CHIEF COUNSELOR
RICHARD KEARNS
CHAIRMAN
BOYS STATE COMMISSION
BARBARA L. DEVAULT
ADMINISTRATOR EMERITUS
EDWARD DENSON
ASST. ADMINISTRATOR
Address:____________________________________________________________________________
Number/Street
City
State Zip
Primary Care Physician:_______________________________________________________________
Name
Phone Number
Are you taking any prescription medications? Y/N_____ (Note: If you are taking prescription medications, you must meet with a
member of the Nursing Staff prior to 11:00 p.m. on the day of your arrival.)
If yes, please list:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Have you had any of the following illnesses?: (Yes or No)
Asthma____________
Measles____________
Scarlet Fever__________
Chicken Pox__________
Mumps__________
Pneumonia________
Typhoid Fever_________
Have you been exposed to any contagious disease in the last three (3) weeks?_______________________________
__________________________________________________________________________________________________
Have you been protected by inoculation or vaccination within 5 years against:
Diphtheria_________Year________
Signature of Delegate__________________________________________________________________
The above applicant is to become associated with approximately 1000 boys for a weeks activities at The American Legion California Boys State. Please
take into consideration that he will probably engage in average outdoor activities and we are desirous of eliminating, as much as possible, the danger of
communicable diseases. Accidents and/or illness may occur that require medical attention. Qualified nurses are on duty 24 hours/day and medical
hospitals are nearby should a medical condition arise.
THE AMERICAN LEGION CALIFORNIA BOYS STATE: MEDICAL CERTIFICATE, CONSENT TO MEDICAL
TREATMENT AND HOSPITAL SERVICES, WAIVER OF CLAIMS & DEFENSES & DELEGATE AND
PARENT/GUARDIANS WAIVER AND RELEASE FORM-PAGE 2
Delegate Name:_____________________________________________
Last
First
Middle
INSURANCE INFORMATION: (To be completed only if parent(s) carry a Group medical Insurance Plan)
Name of Parent(s) Group Insurance Carrier__________________________________
Insurance Policy Certificate/ID Number_________________________
Parent Name to Whom Policy Is Issued____________________
The signature below attests to the accuracy of insurance information that is being provided, the Consent to
Medical Treatment, the Authorization for the use and or publication of image or likeness and the Consent to the
Waiver and Release of Claims.
Signature___________________________________________ Date__________________
Parent Employer Name______________________________________
DELEGATES AND PARENT/GUARDIANS WAIVER & RELEASE FORM
I,__________________________________, am a participant in The American Legion California Boys State program that will be held June
20-27, 2015 (inclusive) at Sacramento, CA. I understand that I have been chosen to represent my High School and sponsoring American
Legion Post as its duly selected representative.
I hereby grant The American Legion my absolute and irrevocable consent for any photograph(s), video film and audio tape taken of me
in the course of my participation in The American Legion California Boys State to be used, published and copied by The American
Legion and its assignees. I release The American Legion, and its assignees, designees, and agents of the organization from any and all
claims arising out of or in connection with the taking, publication and/or use of pictures, photographs, recordings, documents, film and
any other accounts of my likeness or of my participation at The American Legion California Boys State Program including, but not
limited to, any claims for defamation, invasion of privacy, or right of publicity.
ACCEPTED AND AGREED:
Signature:______________________________________________________ Date_____________________
Printed Name:___________________________________________________
Address:_______________________________________________________
City______________________________________ State:_________ Zip Code:___________
NOTE: THIS DOCUMENT MUST ALSO BE READ, APPROVED & SIGNED BY A PARENT/GUARDIAN
I have reviewed the above Waivers & Releases and, on behalf of my son and myself, I approve of his consent to the terms of the Waivers
& Releases and, on behalf of my son and myself, I agree to the terms of the Waivers & Releases. Further, I agree that if for any reason
my son is unwilling to stay at the Program or is requested or required to leave the Boys State Program early, I will arrange to promptly
pick my son up at California State University, Sacramento. Moreover, if, in the sole and exclusive determination of Program officials, I
am unable or unwilling to promptly pick up my son at California State University, Sacramento and alternative transportation
arrangements are made by Program officials for my sons early departure, I will be responsible for the payment of any and all direct and
indirect transportation expenses, liabilities, losses or injuries incurred or suffered as the result of, or in any way associated with, my
sons early departure from the Program.
Signature of Parent/Guardian__________________________________________________
Printed Name:_____________________________________________________ Date:_____________________
Parent/Guardian DAYTIME Phone Numbers:_____________________ ____________________________________________
ELIGIBILITY: High school juniors who are a direct descendant, i.e. child,
grandchild, great-grandchild or a legally adopted child, of a U.S. veteran
who served during a period of war and is a delegate to either an American
Legion Boys State or American Legion Auxiliary Girls State program.
Completing a scholarship application can be a difficult task. Below are some tips to
help you complete your application.
1. Application must be typed or completed online at www.legion.org. Scroll over the
Programs headline at the top of the page, and in the drop-down box, click on
Scholarships. The Samsung American Legion Scholarship will be the 3rd
scholarship from the top.
2. Do not attach any documents or additional pages to the application, except as
required.
3. Review the entire application before completing it. If a field is left blank, it will
count against you. If you cannot answer a question, put a reason in the field.
4. Proofread your answers/essays in this application in addition to having at least
one other person proofread your application. Spelling errors or poor writing skills
will have a negative effect on your chances of receiving the scholarship.
Incomplete/unprofessional applications will be rejected.
5. Use a computer to prepare your final document. Applications will not be considered if
they are handwritten.
6. Each application is judged on its own merit so include any information that makes
you exceptional and a good candidate to receive the award.
7. Keep a copy of everything you submit!
8. Pay close attention to scholarship application deadlines as applications
submitted past the deadline will not be considered. Contact your American
Legion Boys State or American Legion Auxiliary Girls State Program to
determine its application deadline and procedure for submitting the application.
Normally, the application is submitted when you arrive at your respective
program.
Name_________________________________________________________________________
High
School
Record This section is to be completed by a high school official. (May be handwritten.)
Address
_______________________________________________________________________
Number
of students in high school ____________State ________________
Number of studentsZip
in applicant's
class ______________
City __________________________________
_______________
Cumulative
Grade
Point Average (GPA) ______________
scale______
is ______
(i.e.
4 point,Year
6 point,
12 point, etc.)
Telephone
(
) _______________________
Date of BirthGPA
Month
Day
_______
_______
Class
Rank
___________
Expected Date ofof
Graduation
I am the
(state
relationship)___________________
(veteran's _______________
name) ___________________________
SAT
Scores
Math (if
_______
Verbal _______ Written _______ Total _______ and/or ACT Score ___________
Veteran's
address
living)____________________________________________________________
who served on active duty during one or more of the following periods of war. Check the appropriate war period:
______________________________________
___________
___________________________________
____ World War I - Apr. 6, 1917 - Nov. 11, 1918 Date____
Lebanon/Grenada
- Aug. 24, 1982 - Jul. 31, 1984
____ World
War
II
Dec.
7,
1941
Dec.
31,
1946
____
Panama
Dec.
20,
1989 - Jan. name
31, 1990
Signature
Type/print
and title
____ Korean War - June 25, 1950 - Jan. 31, 1955
____ Persian Gulf WarAffix
- Aug.school
2, 1990stamp
- Untilor
Cessation
seal of Hostilities
____ Vietnam War - Feb. 28, 1961 - May 7, 1975
For Department Selection Committee Use Only
PARENT(S) ADJUSTED GROSS INCOME (AGI: FORM 1040--LINE 31,
GPA ________ Class Rank ________
SAT/ACT Score ________ Activities ________
Honors & Awards ________
Please indicate your job or work experiences. List dates from to. List number of hours per
week/month and total hours. List any responsibilities/accomplishments.
In 500 words or less, describe your most significant challenge or accomplishment and explain its value to
your life.
2/8
In 500 words or less, explain your long-range goals for school and career. Describe what specific skills
and personal values you want to foster in yourself to achieve these ends.
3/8
Describe any circumstances that may affect your familys ability to provide for your college education.
Describe any community service /volunteer work in which you have been involved during your high
school career (grades nine through eleven). If your community service/volunteer work was required,
explain why.
4/8
Activities - List the school clubs, teams, and organizations you belonged to or participated in during grades nine
(9) through eleven (11). List the dates you participated (mm/yy), number of hours per week or month, total
hours and accomplishments or honors earned.
List the non-school clubs, teams, and organizations you belonged to or participated in during grades nine (9)
through eleven (11). List the dates you participated (mm/yy), number of hours per week or month, total hours
and accomplishments or honors earned.
5/8
State/National Awards and Honors. List up to five state or national awards/honors you have received. (For
example, All-State Choir, National Merit Semifinalist.)
1.
2.
3.
4.
5.
School/Local Awards and Honors. List up to five school or local awards/honors you have received. (For
example, DAR Good Citizen Award, 4-H, Scholastic Athlete Award.) The fact that you are submitting this
application presumes that you have participated in a Boys State or Girls State Program. Do not include that
program as a School/Local Award or Honor.
1.
2.
3.
4.
5.
In 500 words or less, describe what do you like to do for fun and/or enjoyment?
CERTIFICATION
If I am selected as a scholarship winner and in consideration thereof, I understand, agree and hereby grant permission to
The American Legion and Samsung Group to use my likeness and name in announcing and promoting this scholarship
program. I understand and agree that the National Selection Committee is solely responsible for the selection of the
scholarship winners and its decision is final. I have completed the scholarship application and have attached the veterans
verification document. I grant permission to the school of higher education I attend to release information concerning my
enrollment status, academic standing and financial need to The American Legion for use in administering my scholarship
award. In submitting this application, I certify that the information is complete and accurate to the best of my knowledge.
I understand and agree that falsification of information will result in termination of the Samsung American Legion
Scholarship.
_________________________________________
Student Signature
Date _________________
If my child is selected as a scholarship winner and in consideration thereof, I understand, agree and hereby grant
permission to The American Legion and Samsung Group to use my child's likeness and name in announcing and
promoting this scholarship program. I understand and agree that the National Selection Committee is solely responsible
for the selection of the scholarship winners and its decision is final. My child has completed the scholarship application
and has attached the veterans verification document. I grant permission to the school of higher education my child attends
to release information concerning my child's enrollment status, academic standing and financial need to The American
Legion for use in administering my child's scholarship award. In submitting this application, I certify that the information
is complete and accurate to the best of my knowledge. I understand and agree that falsification of information will result
in termination of the Samsung American Legion Scholarship.
Attach to this application documentation showing veteran served on active duty during eligibility
period(s) indicated on front of this application. SUBMIT COMPLETED APPLICATION TO YOUR BOYS/GIRLS
STATE PROGRAM OFFICIALS AS DIRECTED.
The Rules and Conditions under which the scholarships are awarded and the program administered shall be:
1.
Those eligible to apply for the scholarships shall be students who are direct descendants of U.S. wartime veterans who served during one or more of the
periods of war officially designated as such by the United States government: World War I - April 6, 1917 - November 11, 1918; World War II - December 7, 1941 December 31, 1946; Korean War - June 25, 1950 - January 31, 1955; Vietnam War - February 28, 1961 - May 7, 1975; Lebanon and Grenada - August 24, 1982 - July
31, 1984; Panama - December 20, 1989 - January 31, 1990 and Persian Gulf War - August 2, 1990 to cessation of hostilities as determined by the United States
government.
2.
The annual Samsung American Legion Scholarship applicant pool will include one representative from each American Legion Boys State program; one
representative from each American Legion Auxiliary Girls State program; and one high school junior boy and one high school junior girl from the Department of
Hawaii. From this pool of state finalists scholarship recipients will be selected by the National Committee on Education. These scholarship recipients will be known
as Samsung American Legion Scholars.
3.
Samsung American Legion Scholars will have six (6) years to utilize their scholarship funds from the date of graduation from high school, excluding any
time spent on active military duty or church mission. Remaining State Finalists will have two (2) years to utilize their scholarship funds from the date of graduation
from high school, excluding any time spent on active military duty or church mission.
4.
The Samsung American Legion Scholarship is for undergraduate study at an accredited U.S. college or university. The recipients must be enrolled as a fulltime student to request his/her scholarship funds. The number and amount of the scholarship awards will be determined by the income derived from the Samsung
American Legion Scholarship Trust.
5.
The scholarship funds may only be used to defray necessary costs of the students education (i.e. tuition, room & board, books & supplies, fees and
equipment required by the students particular course of study or school). A student may request any amount up to and inclu ding his/her total scholarship award at one
time. The amount of the fund request cannot exceed the cost of education. Students may make only one (1) request for funds per semester or quarter.
6.
Scholarship checks will be issued upon receipt of a Request for Funds form. It is the normal and customary procedure that the scholarship check will be a
two-party check made payable to the student and school. Students who have not requested their award will receive one (1) written notice reminding them of their
award and the time limits remaining to receive their award. State finalists will receive their notice prior to their last year of eligibility. Samsung American Legion
Scholars will receive their notice with two years of eligibility remaining.
7.
Unused scholarship funds will be returned to the scholarship trust fund for future awards.
7/8
8/8
RICHARD L. SHICK
DIRECTOR
JAMES ALCORN
ASST. DIRECTOR
WILLIAM DENSON
ASST. CHIEF COUNSELOR
RICHARD KEARNS
CHAIRMAN
BOYS STATE COMMISSION
BARBARA L. DEVAULT
ADMINISTRATOR EMERITUS
EDWARD DENSON
ASST. ADMINISTRATOR
May 1, 2015
Dear Parents;
Congratulations! Your son has been earned the high honor of being selected to represent his school
by attending the 2015 Session of The American Legion California Boys State. Your son, along with
1000 other outstanding young leaders of our state, has been chosen on the basis of his academic
achievements, character, citizenship and leadership.
The 2015 Session of The American Legion California Boys State will be held on the campus of
California State University, Sacramento. The delegates will be housed in modern air-conditioned
dormitories and meals will be served in the Dining Commons. We will also be using a wide array of the
facilities that the campus has to offer, including the athletic fields. Our outstanding high school
leaders deserve the best and we look forward to delivering to them a rewarding educational program in
this ideal collegiate setting.
The primary purpose of Boys State is to create better citizens by making the delegates aware of their
responsibilities and obligations in the operation of good government. With most delegates reaching
voting age before the end of 2016, we, in The American Legion, feel your son needs a better insight
into our government and the importance of being a participating citizen. He will receive that at
California Boys State 2015. Our goal is to have him walk away from the week with a greater respect for
those who hold public office and learn that positive changes can be made without revolution or
violence.
By reviewing this packet of information, you will gain a better insight into our program. The following
facts may help to answer some of the questions you may have.
1. All expenses are paid through the sponsorship provided by your local American Legion Post or
other co-sponsoring organization. Each individual, however, will be responsible for any
personal expenses (i.e. purchases from campus vending machines, the Hornet (Campus)
Bookstore, Boys State pictures, etc.) and any damages they may be caused to California State
University, Sacramento property.
2. Adult supervision is provided by a dedicated counseling staff comprised of teachers, attorneys,
public safety professionals and other business professionals who donate their time to deliver
this program.
3. Boys State is not a week long classroom session. The delegates will learn by doing. By
governing themselves, they will truly learn how our system of governing works by experiencing
it. The staff is present to assist and facilitate, but the delegates really do the work.
4. The delegates will elect officials of the city and county where they live (dorm) and as well as all
of the Constitutional Officers of the State and the State Legislature. They will enact laws and
enforce them (through the judicial system) via duly appointed and elected officials from
amongst the delegates themselves.
5. If a law is violated, trials are held and Boys State attorneys handle the case in duly constituted
Boys State Superior Courts, District Courts of Appeal and the Boys State Supreme Court.
6. One of the weeks highlights is the inauguration of the Boys State Governor, the other seven
Constitutional Officers, the Boys State Supreme Court and the Boys State Legislature (Senate
and Assembly). Quite often, the California Governor or other State Constitutional Officers attend
the Inaugural Program and assist in administering the Oath of Office to the newly elected Boys
State officers. Following the Inaugural Program, the delegates visit the State Capitol where the
delegates get the opportunity to visit the Assembly Member and Senator (and/or a senior
member from their staff) from their home District.
7. The program is not all work! We offer an athletic program that offers competition in 3 team
and 2 individual sports. Additionally, each evening a different program is offered from the
Opening Night Program, to Political Party Rallies, to Career and Education Opportunities Night,
to the Jamboree and the Closing Program. These events are coordinated by Director Richard
Shick and Chief Counselor Tim Aboudara, Sr.
8. The local American Legion Post has made a large investment to make it possible for your son to
attend California Boys State. The fees the Post has paid cannot be refunded. It is your
responsibility to insure that your son will be on time for the scheduled transportation
arrangements to get to California State University, Sacramento. If you are bringing him to the
campus, he must arrive before 10:00 a.m. on Saturday, June 20 and remain until at least 11:00
p.m. on Friday, June 26. If your son cannot make this time commitment, please contact your
sponsoring Post so that another delegate can be selected.
Every precaution is taken to avoid accidents and sickness at California Boys State. In addition,
delegates and counselors who do not already have group accident/medical insurance are covered by a
group policy underwritten by Sentry Insurance Company. The Sentry policy issued to The American
Legion California Boys State is excess coverage above and beyond any other valid and collectible
insurance coverage. (This exclusion does not apply to individual accident and insurance policies.)
Should an unforeseen need arise for this insurance program, more detailed information will be
provided to you at that time by The American Legion.
On behalf of our Department Commander, Janet Wilson, please again accept our congratulations on
your sons selection to attend this once in a lifetime program.
Sincerely,
RICHARD L. SHICK
DIRECTOR
JAMES ALCORN
ASST. DIRECTOR
WILLIAM DENSON
ASST. CHIEF COUNSELOR
RICHARD KEARNS
CHAIRMAN
BOYS STATE COMMISSION
BARBARA L. DEVAULT
ADMINISTRATOR EMERITUS
EDWARD DENSON
ASST. ADMINISTRATOR
strongly discourage you from bringing a computer. The newspaper staff will be chosen Saturday afternoon
following the Bar Exam.
Any delegate intending to practice law or who plans to run for a Legal office (District Attorney, Superior Court
Judge, appointed City Attorney, Appeals Court Justice, Attorney General and Supreme Court Justice) must
pass the Bar Exam. The Bar Exam will be administered at 3:15 p.m. on Saturday, June 20th. The results will
be available prior to the filing of nomination petitions for City offices on Saturday evening. The Bar Exam is
based on information you have received in your classes in school as well as the Boys State Manual of
Government which is available to download from the The American Legion California Boys State Homepage
(www.boysstatecalifornia.org). Below are some sample questions from previous Boys State Bar Examinations:
1. What is the supreme law of the land?
2. What are the three branches of government?
3. Is it possible to amend the U.S. Constitution by plebiscite?
4. How many amendments have been added to the U.S. Constitution?
5. When and how did California become a state?
6. When was the present California Constitution adopted?
7. How many amendments have been added to the California Constitution?
8. What is an ex post facto law?
9. Which state official represents the state in court?
10. What is the difference between a civil and criminal suit?
11. What are the duties of a Grand Jury?
12. What are the duties of a Coroners Jury?
13. At a trial, does a jury decide the points of fact or the points of law?
14. Explain: acquittal, judgment, subpoena, warrant, recognizance, recidivist
15. True or false: A bailiff is one who does not report for trial and forfeits bail.
16. Define: felony, misdemeanor and indictment
Boys State delegates are welcome to visit the Campus Bookstore and tour the campus. Delegates may not
use any item purchased at the Hornet Bookstore for any type of Boys State campaign. Touring the campus
and visiting the Bookstore is not permitted during scheduled Boys State activities.
In this package you will find information about City Pictures, City T-shirts California Boys State gym shorts and
the opportunity to join the California Boys State Alumni Association. Please look through this information and
consider planning on purchasing a City picture and joining the Alumni Association.
We hope this preliminary information is useful as you prepare to join us at the 2015 Session of California Boys
State. I look forward to seeing you in Sacramento.
Sincerely,
RICHARD L. SHICK
DIRECTOR
JAMES ALCORN
ASST. DIRECTOR
WILLIAM DENSON
ASST. CHIEF COUNSELOR
RICHARD KEARNS
CHAIRMAN
BOYS STATE COMMISSION
BARBARA L. DEVAULT
ADMINISTRATOR EMERITUS
EDWARD DENSON
ASST. ADMINISTRATOR
On Sunday, June 21, group pictures will be taken of each Boys State City. The City picture is a
terrific remembrance of your Boys State experience.
The color photos are 8 x 10. They must be ordered and payment received by 5:00 p.m. on
Monday, June 22. Payment will be made to your City Treasurer.
The price for the City Picture is $5.00.
You will receive your photo before returning home.
++++++++++++++
Two of the highlights of The American Legion California Boys State Program are the Band and the Jamboree.
Please find below information on both if you are interested in participating.
BAND: Each year the Boys State Band plays an integral part in enhancing the weeks activities. The Band
performs at the Opening Program, during the political party rallies, the Inaugural Program and the Closing
Program.
If you play an instrument and would like to be a part of the band, please bring your instrument with you. (If you
play the drums, please do not bring them with you. We will have a set of drums for the band to use.) The first
meeting of the band will be held after the Bar Exam on Saturday afternoon.
st
If you intend to play in the band, please complete the form below and mail by June 1 .
JAMBOREE: One of the other highlights of the Boys State Program is the Jamboree held on Thursday evening.
This is a talent show put on by the Boys State Delegates. You should prepare your act before coming to
Sacramento. If you need a musical instrument, you must bring it with you.
Your City Counselor will let you know when you are to meet with the Music Counselor regarding your musical
number or act.
This show is always a great event. Plan on being a part of it!
If you have experience working back stage, (Stage Manager, lights, sound system, etc.) or being a Master of
Ceremonies, you will be able to sign up after you arrive at Boys State.
BOYS STATE BAND SIGN-UP
Please complete the information and mail to:
Barbara DeVault
6920 9th Avenue
Rio Linda, CA 95673-2415
Please mail no later than June 1, 2015
Name:________________________________________________________________
Address:______________________________________City:__________Zip:_______
School:_______________________________ email:__________________________________
Instrument:_____________________________________________________________
Position in your School Band:_______________________
Part:_____________________
MEMBERSHIP DONATION
A minimum donation of $20.00 is required to be submitted along with the
completed Membership Application. The donation is tax deductible from your
California State Income Tax under Section 23701 (d) of the California Revenue
and Taxation Code and from Federal Income Tax under Section 501 c (3) of the
Internal Revenue Code.
A Membership Application will be available from your City Counselor. We ask
that you complete the application as soon as possible upon arrival at The
American Legion California Boys State and return it to your City Counselor
with your cash or check donation. An Alumni Pin and wallet size membership
card will be issued upon receipt of the Membership Application and donation.
A membership roster is maintained and periodic newsletters are sent to
Alumni Associates to keep them informed of Foundation and Alumni
Association activities.
As a delegate to the 2015 Session of California Boys State, you are eligible to
become an Alumni Associate member. If you wish to join, application forms
will be available upon your arrival at Boys State. It is recommended that you
bring a check in the amount of your donation made payable to: The American
Legion California Boys State Foundation. Please consider joining to help
support future delegates to this great program.
American Legion
California Boys State
City T-Shirts
MD-LG-XL-XX
VERY limited XX available
Proceeds to benefit
the American Legion
Boys State Foundation
23 variations by city
Proceeds
American Legion
California Boys State
Athletic Shorts
C2 Sport Performance Shorts
9 inch inseam
Available in only ONE color
BLACK
Available in 5 sizes
SM-MD-LG-XL-XX
very limited SM and XX
RICHARD L. SHICK
DIRECTOR
JAMES ALCORN
ASST. DIRECTOR
WILLIAM DENSON
ASST. CHIEF COUNSELOR
RICHARD KEARNS
CHAIRMAN
BOYS STATE COMMISSION
BARBARA L. DEVAULT
ADMINISTRATOR EMERITUS
EDWARD DENSON
ASST. ADMINISTRATOR
Follow the 78th Session of The American Legion California Boys State!
There are many ways to follow and interact with this years session of The American Legion
California Boys State.
Our Website: This year, we are planning on posting the Boys Stater-the Boys State Newspaper
on our website. In addition, we plan to post at least one daily feature and pictures of some
of the events taking place over the course of the week. The website address is:
www.boysstatecalifornia.org.
Facebook: Follow us on Facebook and be sure to Like us.
www.facebook.com/CaliforniaBoysState
Twitter/Instagram: @CABoysState
YouTube: www.youtube.com/user/CABoysState