Tallahassee Alumnae Chapter, Delta Sigma Theta Sorority, Inc. Youth Educational Development Programs Registration (2021-2022)
The information provided in this registration form will be used for participation in the Dr. Betty Shabazz Delta Academy or Jean L. Noble Delta G.E.M.S. programs, statistical, and reporting purposes only.
Please complete all sections fully. The deadline for registration is 5:00 p.m., October 7, 2021.
If a youth meets all criteria to participate in the program, the youth and a parent/guardian must attend the virtual program orientation. The virtual orientation for all youth initiatives programs will be held on Saturday, October 16, 2021. The time for the orientation will be provided at a later date.
Note: This all information will be considered confidential and will not be disseminated to the public. Any personally identifiable information (i.e. full name, school, etc.) will not be disclosed during any virtual programming, or otherwise to the public.
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Dr. Betty Shabazz Delta Academy (Grades 6-8)
Delta G.E.M.S. (Grades 9-12)
Applicant Name (Last Name, First Name)
Applicant Email Address
Applicant Phone Number
Returning Program Participant
Date of Birth
Name of School
Grade in School
Guidance Counselor Name (if known)
Parent/Guardian Name (Last Name, First Name)
Parent/Guardian Relationship to Applicant
Parent/Guardian Phone Number
Emergency Contact Name
Emergency Contact Relationship to Applicant
Emergency Contact Phone Number
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