2025-2026 Dr. Betty Shabazz Delta Academy Application

Delta Sigma Theta Sorority, Inc. Westchester Alumnae Chapter's Dr. Betty Shabazz Delta Academy is designed to offer girls of the African Diaspora, ages 11-14, access to an affirming space that empowers and challenges them to become change agents in their communities. Our goal is to guide girls into womanhood with educational support and professional guidance that will teach them how to create opportunities for academic success, enhance their decision-making, communication skills, and develop their abilities and talents to compete in a global society. Through programming, mentorship and fun activities, we will focus on Self-Esteem building, Social Action, Health & Wellness, Technology, The Arts and much more.

The Delta Academy is designed for young women who meet the following criteria:

▲ Middle School Age, 11 to 14 years old (6th-8th Grade)

▲ Resides or attends school in Westchester County

▲ Demonstrates great academic and personal promise

▲ Shows interest in developing leadership skills

▲ Shows interest in community action and social change

▲ Shows interest in non-traditional STEM (science, technology, engineering, and mathematics) careers.

Delta Academy will launch their Parent and Youth Orientation, virtually, on Thursday, October 2, 2025 at 7:30PM and continue mentoring sessions monthly through June 2026. All mentoring sessions will be held in person with some virtual sessions during inclement weather as determined by the Delta Academy Committee.

PROGRAM DATES

*Parents/guardians will be notified in advance of any changes to the dates listed below.

Parent/Youth Orientation (Virtual) -Zoom link to follow. Parent and Youth are required to attend - Thursday, October 2, 2025 at 7:30pm.

Times: 10:00am-1:00pm

o   Session 1- October 25, 2025

o   Session 2- November 22, 2025

o   Session 3- December 13, 2025

o   Session 4- January 24, 2026

o   Session 5- February 14, 2026

o   Session 6- March 21, 2026

o   Session 7- April 11, 2026

o   Session 8- May 16, 2026

o   Session 9- June 13, 2026, End of the Year Celebration

APPLICATION DEADLINE

Applications will be accepted until September 30, 2025. Admission is available on a first-come, first-served basis.

For more information, please contact DeltaAcademy@dstwac.org.
STUDENT INFORMATION
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
HEALTH
Cell Phone Number
Please enter a valid phone number.
Email
example@example.com
Date of Birth

MonthDayYear

Emergency Contact Information*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Conditions *
Is your daughter taking any medication? If so, please provide the name and the # of times she would need to take it throughout our session. *

ACADEMICS
School Name*
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
School Phone Number*
Please enter a valid phone number.
Grade*
Guidance Counselor's Name*

PARENT/GUARDIAN INFORMATION
Parent/Guardian Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Relationship to Student*
How did you hear about the Dr. Betty Shabazz Delta Academy Program?*
Why would you like to see your child participate in the Dr. Betty Shabazz Delta Academy Program? What are your expectations?*
Are there any concerns that we should be mindful of while mentoring your participant (personal, social anxiety, IEP, etc.)?
What are some of your daughter's interests, hobbies and favorite subject(s)? Is there a specific cause she is passionate about?
Please download and review all (13) documents and sign and upload Appendix B1-9B, B10.

(1) Appendix B1: Parental/Guardian Affirmation

(2) Appendix B2: Photograph, Media, and Video Authorization Release

(3) Appendix B3: Youth Code of Conduct for In‐Person Meetings

(4) Appendix B4: Youth Pick‐up Authorization

(5) Appendix B5: Waiver and Permission to Transport Youth

(6) Appendix B6a & 6b: Parent Waiver and Permission for Youth To Be Transported by Teenage Driver

(7) Appendix B7: Off‐site Permission

(8) Appendix B8: Medical and Emergency Contact Information

(9) Appendix B9, B9.1, B9.2: Virtual Meeting/Event Participant Agreement

(10) Appendix B10: Parent/Guardian Acknowledgement Of Informational Forms

(11-13) Appendix B11, B12, B13: Confidentiality Policy, Youth Sign‐In/Sign‐Out Policy, Internet Youth Policy

Please continue to the next page to download all required forms.

Required Documents
File Upload *

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STUDENT INFORMATION

HEALTH

ACADEMICS

PARENT/GUARDIAN INFORMATION