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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Email *
Do you have access to stable internet connection? *
Do you have access to a device which allows use of a camera and microphone? *
Program Selection *
Applicant Name (Last Name, First Name) *
Applicant Email Address
Applicant Phone Number
Applicant Type
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Date of Birth *
MM
/
DD
/
YYYY
Address
Phone Number
Name of School
Grade in School *
Guidance Counselor Name (if known)
Dietary Restrictions?
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Parent/Guardian Name (Last Name, First Name) *
Parent/Guardian Relationship to Applicant
Parent/Guardian Email *
Parent/Guardian Phone Number *
Emergency Contact Name *
Emergency Contact Relationship to Applicant
Emergency Contact Phone Number *
Shirt Size
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