Junior/Senior Prom guest form

Needham B. Broughton High School

Junior/Senior Prom Guest Selection Committee


723 Saint mary’s Street

Raleigh, NC 27605

phone: 919.856.7810

fax: 919.856.7822






April 2016
Dear Broughton Juniors & Seniors:


If you plan to invite a guest to the 2016 Junior/Senior Prom who is not a current Broughton High School student, you must complete the attached application. All dance attendees are expected to comply with school rules and regulations, and to be courteous to each other, employees of the school district, and volunteer chaperones. Please note the following guidelines in selecting your guest for the Junior/Senior Prom:


  • High school graduates and college students are eligible to attend the dance.
  • If your guest drops out of another school, the guest must have an endorsement from that school stating that he or she left in good standing. It must be attached to the application.
  • All guests must have the statement of character completed by the appropriate person listed for their current status.
  • All guests must attach a clear photocopy of a current High School ID or Driver’s License showing date of birth with the attached application.
  • Any student or guest using alcohol or any controlled or illegal substances are subject to all school rules and regulations. Any student or guest found in violation of the above rule will be removed from the dance and disciplined in accordance to Wake County School Board Policy 6429.
  • All dance attendees must present valid picture identification at the registration table the night of the dance in order to be admitted.


All information must be completed and the photo identification MUST be attached for the application to go through the approval process.

Return completed applications to the main office on or before Tuesday, April 26. We encourage you to return your application as soon as possible so that you will know if your guest has been approved sooner than later. Tickets will not be sold to guests that have not been approved through the application process.


Please contact Ms. Lockwood (3213) for questions. [email protected]







Junior & Senior Prom Guest Application

Needham B. Broughton High School
723 St. Mary’s Street

Raleigh, North Carolina 27605

919-856-7810 (office)   919-856-7822 (fax)

BHS Student:   ________________________    _________________________ Grade: _______

      (Last Name)                                                         (First Name)

The following information must be provided in order to determine eligibility of guests to attend the
Broughton High School Junior/Senior Prom:


  1. Guest’s Name: ____________________________         _____________________________

                                                                         (Last Name)                                                                       (First Name)

  1. Guest’s Date of Birth: __________________ Phone(s) # _____________  _____________

                                                                       (month/day/year)                                                 (home)                           (cell)
3.   Guest’s Parent’s Name: _______________________________  Phone#  _____________

4. Guest’s current status (Circle One):

High School Student            College Student         Worker          Active Military


  1. Depending upon your guests current status, complete the following information that
    applies to your guest (Select One):


  • School guest attends at present: _______________________________
  • Guest’s place of employment: _______________________________
  • Guest’s Branch of Service: _______________________________


  1. Statement of Character: By School Administrator if the guest is a high school student at
    present; Professor/Dean if the guest is a college student at present; Employer if the guest is
    a graduate and is working at present; Commanding Officer if the guest is in the military at
    present; or Minister if the guest is home schooling at present. Character statements by relatives or parents of the guest’s date will not be accepted. (Attach an additional sheet if necessary) __________________________________________________________________________

_____________________________________    ______________________________

Signature of person making statement of character                              Printed Name
___________________________________                     ___________________
Title                                                                                                                     Daytime Phone Number

High School Administrator Use Only:
Has this student been suspended this school year?       ____ Yes           ____No
If the student has not been suspended, are there any other concerns BHS needs to be aware of? If so,
please explain __________________________________________________________________________
Administrator’s Signature


  1. A Copy of a picture ID must be attached to the application. – The ID will also need to be presented the night of the Prom in order to be admitted. (Ex: School ID, Driver’s License or State ID card, etc.)

Return this completed application to the Main Office on or before: Tuesday, April 21, 2014.