Delta G.E.M.S. Application
Thank you for your interest in the Delta G.E.M.S. program. Please complete this application.
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Date of birth
*
-
Month
-
Day
Year
Date
Current highshcool
*
Grade
*
9th grade
10th grade
11th grade
12th grade
Is this your first time participating in the Delta G.E.M.S. program?
*
Yes
No
What would you like to learn from participating in the Delta G.E.M.S. program?
*
List any accomplishments, awards, honors/honor societies, or recognition you have received including the date received.
*
What career(s) interest you? Please explain.
*
How did you find out about the Delta G.E.M.S. program?
*
What are your plans after graduating from high school?
*
What colleges/universities/trade schools are you interested in applying to?
*
Are you presently participating in any extra-curricular programs (e.g. sports, arts, community, church)? If so, please list them and their time commitments.
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Email address (parent/guardian)
*
example@example.com
T-shirt size
*
Small
Medium
Large
XLarge
XXLarge
Preferred Method of Contact. Please select one.
*
Phone
E-mail
Are you available the 1st Saturday of every month between 11:00-12:30 pm?
*
Yes
No
I have my parent's permission to participate in the Delta G.E.M.S. program.
*
Yes
No
I agree to participate and follow all expectations of the Delta G.E.M.S. Program. Please intial.
*
Submit
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