2025 Crimson & Cream Cotillion Sign-Up

2025 Crimson & Cream Cotillion Sign-Up

Cotillion Sign-Up form and official transcripts must be submitted by March 1, 2025. Transcripts can be sent via mail or email. Please email transcripts to: dstcotillionpeoria@gmail.com. Please mail transcripts to: Delta Sigma Theta – Peoria Alumnae Chapter, Attn: Cotillion Committee, P.O. Box 386, Peoria, IL 61651-0356
Future Debutante Information

All debutantes must be current 12th grade High School students, and will not reach the age of 20 by graduation.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
High School*
Age*
Birthday*

MonthDayYear
Date
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Secondary Parent/Guardian Name

First NameLast Name
Secondary Parent/Guardian Phone Number
Please enter a valid phone number.
Secondary Parent/Guardian Email
example@example.com
Father Figure and Escort Information

Escorts must be between the ages of 14-19. If you have an idea of who your escort will be, please include their contact information below - even if you have not confirmed their participation.
Father Figure's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Escort's Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com

2025 Crimson & Cream Cotillion Sign-Up

Future Debutante Information

Emergency Contact Information

Father Figure and Escort Information