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| POWER OF 10 CONTESTANT QUESTIONNAIRE |
| TAKE YOUR TIME & ANSWER ALL QUESTIONS HONESTLY AND COMPLETELY. WHEN FINISHED, REVIEW YOUR ANSWERS AND SUBMIT YOUR APPLICATION. |
| YOU WILL ALSO BE ASKED TO ATTACH/UPLOAD A RECENT PHOTO OF YOURSELF AFTER COMPLETING THIS FORM. |
| NAME |
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| AGE |
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| BIRTH DATE |
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| CURRENT ADDRESS |
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| CITY/STATE |
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| HOMETOWN (WHERE DID YOU PRIMARILY GROW UP) |
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| HOME PHONE |
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| WORK PHONE |
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| CELL PHONE |
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| E-MAIL |
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| STATUS (MARRIED, DIVORCE, SINGLE, ENGAGED, DATING) |
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| IF MARRIED OR DATING, NUMBER OF YEARS? |
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| # OF CHILDREN |
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| YOUR CHILDREN(S) AGES |
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| HIGHEST LEVEL OF EDUCATION COMPLETED |
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| YOUR CURRENT OCCUPATION/PROFESSION |
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| BRIEF JOB DESCRIPTION? |
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1. What do you love/dislike about your job? What inspired you to choose that career field?
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2. Tell us three unique stories about you (such as stories most likely told to friends, funny anecdotes or encounters, etc.) Please be thorough.
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3. Is there something about you that would shock the people closest to you, if they were to find out?
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4. What is the most outrageous or daring thing you have ever done?
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5. What is your personal motivation for wanting to be selected for this game show?
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6. Are you a penny pincher or big spender? Explain your answer & give examples.
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7. How would 10 million dollars change your life?
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8. Do you consider yourself to be lucky or unlucky? Explain why you feel this way & give examples.
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9. Do you think you handle pressure well? What do you do to calm yourself down?
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10. What do you like about polling?
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11. Why do you think you could win big on this show?
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12. How well do you really know what Americans think? Explain why.
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| During the show, if you could consult up to 5 people, who would you choose? Please describe them below: |
1.Consult Name #1
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1.City / State
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1.Relationship, Age
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1.Why?
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1.Contact#
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2.Consult Name #2
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2.City / State
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2.Relationship, Age
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2.Why?
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2.Contact#
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3.Consult Name #3
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3.City / State
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3.Relationship, Age
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3.Why?
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3.Contact#
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4.Consult Name #4
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4.City / State
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4.Relationship, Age
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4.Why?
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4.Contact#
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5.Consult Name #5
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5.City / State
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5.Relationship, Age
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5.Why?
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5.Contact#
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Have you ever appeared on television before (such as game show, reality, talk show and news programs etc.)? If yes,please list all television appearances below, along with airdate & prize money if applicable.
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| REVIEW YOUR ANSWERS AND THEN CLICK THE BUTTON TO SUBMIT YOUR APPLICATION. |
| Once we have reviewed your application, a casting producer may contact you with more details and the next steps to be considered as a contestant for Power of Ten. You can also contact the casting dept @1.877.949.POWER |
| THANK YOU AND GOOD LUCK!. |
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