2019-2020 Delta Student Application
Please complete the entire application and click SUBMIT at the end. It is extremely important to enter accurate information. If you cannot be contacted your seat at Delta will be forfeited. Seats at Delta are very limited and interest is high. Students are chosen by computerized lottery in March and will be notified at that time. If you are not initially selected in the lottery you will be placed on a wait list for any available seat. **APPLICATIONS MUST BE RECEIVED BY 3:00 PM, THURSDAY, FEBRUARY 14TH, 2019. **
Student Full Name *
Your answer
Student Email Address *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Current School Student ID # *
(if private school or homeschool, please enter "1111")
Your answer
Student Home Address (Street) *
Your answer
Student City *
Your answer
Student Zip Code *
Your answer
Primary Phone Number *
Please include area code
Your answer
Student Ethnicity *
Language Spoken At Home *
Current Middle School *
I live in the boundaries of the: *
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 plan *
A 504 is a health accommodation plan.
Parent/Guardian Name #1 *
Please include first and last names.
Your answer
Parent/Guardian #1 Home/Cell Phone Number *
Please list the best number to contact this parent/guardian.
Your answer
Parent/Guardian #1 Address
Only necessary if address is different than the address listed for the student.
Your answer
Parent/Guardian #1 Email Address
Your answer
Parent/Guardian Name #2, if applicable
Please include first and last names.
Your answer
Parent/Guardian #2 Home/Cell Phone Number
Please list the best number to contact this parent/guardian.
Your answer
Parent/Guardian #2 Address
Only necessary if address is different than the address listed for the student.
Your answer
Parent/Guardian #2 Email Address
Your answer
Reference #1: Name *
Please list an adult at your school that 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. If you are homeschooled you may list other adults known outside of your home.
Your answer
Reference #1: Relationship *
What is your relationship to the reference?
Reference #1: Work Phone Number *
Phone number of reference--please include area code.
Your answer
Reference #2: Name *
Please list an adult at your school that 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. If you are homeschooled you may list another adult known outside of your home.
Your answer
Reference #2: Relationship *
What is your relationship to the reference?
Reference #2: Work Phone Number *
Phone number of reference--please include area code.
Your answer
Submit
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