2026-2027 Dr. Betty Shabazz Delta Academy Application

Dr. Betty Shabazz Delta Academy

2026-2027 Application Application Deadline - July 1, 2026 5PM
Please read and follow the instructions carefully prior to submitting your application. Participants selected will be notified on or before the 10th of August 2026.

This application is for rising 6th, 7th, and 8th grade young ladies in the 2026-2027 school year.

All correspondence will be generated from the personal information submitted below. Please check opportunities that all information and email addresses are correct including any capitalization and punctuation.

**Parent #1 will be the primary contact for all correspondence
I. Student Data

Tell us about yourself
Full Name:

First NameMiddle NameLast Name
Cell Phone Number:
Format: (000) 000-0000.
E-mail Address:
Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
II. School Information:
Name of School for 2026-2027 School Year:
School

Other
Grade Level for 2026-2027 School Year:
Age:
This upcoming year will be my_____ year participating in Delta Academy.
Choose One.
Is your mother, or grandmother a member of Delta Sigma Theta Sorority, Incorporated?
If your mother, or grandmother is a member of Delta Sigma Theta Sorority, Incorporated, please provide the name and your relationship to the member.
III. Parent / Guardian Information
Parent / Guardian #1 Name:

First NameLast Name
Parent / Guardian #1 E-mail Address:
Email where all correspondence for the program year will be sent.
Parent / Guardian #1 Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian #1 Mobile Number:
Format: (000) 000-0000.
Can we text you using the cell phone number listed?
Parent / Guardian #2 Name:

First NameLast Name
Parent / Guardian #2 E-mail Address:
Email where all correspondence for the program year will be sent.
Parent / Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent / Guardian #2 Mobile Number:
Format: (000) 000-0000.
IV. Extra-Curricular Activities
Please provide a list of ongoing activities in which you will be engaged during the 2026-2027 school year (e.g. clubs, sports, jobs, church and community activities):
Please indicate which of the following activities would be of most interest to you as part of the program:

Other
Meetings are usually held on the third Saturday of each month for approximately 2 hours. Are you able to meet this commitment? (Choose one.)
V. Written Response

Please respond to the question that is applicable to your Academy status
New Applicants Only

Why do you want to be a part of the Delta Academy program and what do you hope to learn or gain by participating in the program? Your response should be no more than 300 words.
Essay:

Your response should be no more than 300 words in the space above.0/300
Returning Applicants Only

As a returning member, there is an expectation of engaged participation. Explain you plan to be more engaged and be an active participant of Delta Academy. Your response should be no more than 300 words.
Essay:

Your response should be no more than 300 words in the space above.0/300
Applicant's Signature

By signing in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature
Parent/Guardian Signature
Parent / Guardian, by signing in the space below, you are certifying that all information is correct. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
Signature
Date:

MonthDayYear
Charlotte Alumnae Chapter Delta Sigma Theta Sorority, Inc.
Should be Empty:

Dr. Betty Shabazz Delta Academy

I. Student Data

II. School Information:

III. Parent / Guardian Information

IV. Extra-Curricular Activities

V. Written Response

Applicant's Signature

Parent/Guardian Signature

Charlotte Alumnae Chapter Delta Sigma Theta Sorority, Inc.