2018-2019 Delta Student Application
Please fill out the entire application. It is extremely important to enter accurate information. If you cannot be contacted, your seat may be forfeited. Seats at Delta are very limited and interest is high.  Students are chosen by computerized lottery in March and will be notified after that date. If you are not initially selected in the lottery, you will be on a wait list for any available seat. **APPLICATIONS MUST BE RECEIVED BY 3:00 p.m. THURSDAY, FEBRUARY 15TH, 2018.**
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Last Name *
First Name *
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Student Current School ID # *
(If you are private or homeschooled, please enter "1111".)
Student Home Address *
Student City *
Student Zip Code *
Phone Number *
Student Ethnicity *
Language Spoken at Home *
Current Middle School *
I live in: *
If I do not attend Delta, my boundary high school is: *
My 8th grade math class is: *
I am currently on an IEP: *
An IEP is a special education plan.
I am currently on a 504: *
A 504 is a health accommodation plan.
Parent/Guardian Name #1 *
Please include first and last names.
Parent/Guardian Name #1 Address
Please include if this is a different address than the one listed by the student, above.
Parent/Guardian #1 Home/Cell Phone *
Parent/Guardian #1 Work Phone
Parent/Guardian #1 Employer
Parent/Guardian #1 E-mail
Parent/Guardian #2, if applicable
Please include first and last names.
Parent/Guardian #2 Home/Cell Phone
Parent/Guardian #2 Work Phone
Parent/Guardian Name #2 Address
Please include if this is a different address than the one listed by the student, above.
Parent/Guardian #2 Employer
Parent/Guardian #2 E-mail
Reference #1 *
Please list an adult you feel knows you well. We may ask about your work habits, your potential, and your ability to be flexible in a small school environment.
Reference #1 *
What is your relationship to the reference?
Reference #1 *
Phone Number
Reference #2 *
Please list an adult you feel knows you well. We may ask about your work habits, your potential, and your ability to be flexible in a small school environment.
Reference #2 *
What is your relationship to the reference?
Reference #2 *
Phone Number
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