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              E A G L E Questionnaire

Name: _________________________________   Grade: _________________

Phone Number: ___________________     School: ___________________

Parent(s) Name: _________________________________________________

__________________________________________________________________

__________________________________________________________________       

Pets (Name & Type)

__________________________________________________________________

Favorite:
       Food _____________________     TV Show _____________________

       Movie ____________________     Class _________________________

       Sport/Activity ______________________________________________

When I grow up I want to be ___________________________________

If I won a million dollars I would _______________________________

__________________________________________________________________

If I could meet any person it would be ________________________

Your luxury item requests in order of preference:

     1. ___________________________________

     2. ___________________________________

     3. ___________________________________

I understand the rules and requirements of EAGLE

________________________________________          __________________
      Name of EAGLE member                                   Date

I understand the rules and requirements of EAGLE and give permission of the above signed participant.

________________________________________          __________________
      Parent or Legal Guardian                                   Date