Fillable Delta Sigma Theta Sorority, Incorporated Youth Group Student

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Delta Sigma Theta Sorority, Incorporated Youth Group Student

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Prince George’s County Alumnae Chapter
Delta Sigma Theta Sorority, Incorporated
Youth Group Student Application Form
2020-2021
1
Student’s Name: ____________________________________________________
Date of Birth: __________________ Age: __________________
School: ____________________________________________________________
Grade Level: ____________ Last Grade Point Average: ___________
Address: __________________________________________________________
City: _____________________________ State: _____ Zip Code: _____________
Cell Number: ____________________ Home Number: ____________________
E-mail Address: _____________________________________________________
Which PGCAC Youth Group Are You Appling For:
Dr. Betty Shabazz Delta Academy (Females - Grades 6-8)
Delta GEMS (Females - Grades 9-12)
EMBODI (Males - Grades 8-12)
Name: ___________________________________________________________
Cell Number: ____________________
E-mail Address: ____________________________________________________
Name: ___________________________________________________________
Cell Number: ____________________
E-mail Address: ____________________________________________________
Student Contact Information:
Parent(s)/Guardian(s) Contact Information:
Prince George’s County Alumnae Chapter
Delta Sigma Theta Sorority, Incorporated
Youth Group Student Application Form
2020-2021
2
Student Information:
1. Favorite school subjects:
___________________________________________________________________
___________________________________________________________________
2. List extracurricular activities (including school, community or church activities):
___________________________________________________________________
___________________________________________________________________
3. Hobbies/Talents:
___________________________________________________________________
___________________________________________________________________
4. What are your plans/goals after high school?
___________________________________________________________________
___________________________________________________________________
5. Are you a previo
us Youth Group participant? _____ YES ______ NO
6. Have you ever par
ticipated in a mentoring program(s)? _____ YES ______ NO
If so, please give the name of the program(s):
___________________________________________________________________
___________________________________________________________________
7. How did you hear about our Youth Programs?
___________________________________________________________________
___________________________________________________________________
Prince George’s County Alumnae Chapter
Delta Sigma Theta Sorority, Incorporated
Youth Group Student Application Form
2020-2021
3
All Dr. Betty Shabazz Delta Academy and Delta GEMS participants must answer the essay
topic below. The essay must be legibly hand-written (do not use pencil) or typed and submitted
along with your application. Your essay must be between 150 and 200 words in length.
1. Describe why you want to participate in the Prince George’s County Alumnae Chapter’s
Youth Program, and what experiences would you like to gain by participating. Note: Please
remember to state which program you are applying for.
8. List suggested topics that you would like to discuss this year:
a. ______________________________________________________________
b. ______________________________________________________________
9. List activities or community service projects you would like to participate in this year:
a. ______________________________________________________________
b. ______________________________________________________________
Prince George’s County Alumnae Chapter
Delta Sigma Theta Sorority, Incorporated
Youth Group Student Application Form
2020-2021
4
Short Essay (150 – 200 Words)
Prince George’s County Alumnae Chapter
Delta Sigma Theta Sorority, Incorporated
Youth Group Student Application Form
2020-2021
5
Application Submission
All applications must be completed, signed and submitted, along with a 3x5 photo, no
later than August 31, 2020 to the following e-mail address:
Dr. Betty Shabazz Delta Academy: Bettyshabazz@pgcacdst.org
Delta GEMS: Deltagems@pgcacdst.org
EMBODI: EMBODI@pgcacdst.org
Please note: If you are selected for the program, you and your parent MUST attend the Kick-
off/Orientation session. Notification of acceptance will come through e-mail.
By my signature below, I hereby verify that the above information is accurate.
(YOU MUST SIGN and DATE this application.)
_________
_______________________________ _________________________________
Student Signature Date
_________
________________________________ _________________________________
Parent/Guardian Signature Date
For official use only:
Date Received:
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Delta Sigma Theta Sorority, Incorporated Youth Group Student

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Completed 12 March 2021

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