2026 - 2027 Educational Development Application
Henry County Alumnae Chapter- Delta Sigma Theta Sorority, Incorporated
1. Participant's Name:
*
First Name
Last Name
2. Participant's Date of Birth:
*
-
Month
-
Day
Year
Date
3. Parent/Guardian's Name:
*
First Name
Last Name
4. Parent/Guardian's Phone Number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
5. Parent/Guardian's Email Address:
*
example@example.com
6. What committee program are you applying?
*
Please Select
GEMS - Girls ONLY (High School)
Academy - Girls ONLY (Middle School)
EMBODI - Boys ONLY (Middle & High School)
7. Are you a Henry County Resident?
*
Yes
No
8. Does your student attend school in Henry County?
*
Yes
No
9. School Name (Select your Middle or High School from the list below):
*
Please Select
Dutchtown Middle School
Eagle's Landing Middle School
Hampton Middle School
Locust Grove Middle School
Luella Middle School
McDonough Middle School
Ola Middle School
Stockbridge Middle School
Union Grove Middle School
Woodland Middle School
Dutchtown High School
Eagle's Landing High School
Hampton High School
Locust Grove High School
Luella High School
McDonough High School
Ola High School
Stockbridge High School
Union Grove High School
Woodland High School
OTHER
10. If you chose "Other" for school name above please list your school's name below:
*
11. If you chose "Other" for school name above please list your school's address below:
*
12. Grade Level for the 2026-2027 School Year:
*
Please Select
6th
7th
8th
9th
10th
11th
12th
13. T-Shirt Size:
*
Please Select
Small
Medium
Large
X-Large
2XL
Please select your size with the understanding the shirts will be in Adult Sizes
14. How did you hear about the program?
*
What are your student's hobbies/extra-curricular activities?
*
15. Is the applicant a returning participant?
*
Yes
No
16. Is the participant's parent a member of Delta Sigma Theta Sorority, Incorporated?
*
Yes
No
17. Is this a single parent household?
*
Yes
No
18. Does the participant receive free or reduced lunch?
*
Yes
No
19. Has the participant ever been expelled from school?
*
Yes
No
20. If you have been expelled, please tell us when?
*
Yes
No
21. Has the participant ever been arrested?
*
Yes
No
22. If you have been arrested, please tell us when?
*
23. Please provide a brief summary of the participant's career goals?
*
24. Please provide a list of the participant's scholastic achievements/awards (Honors, AP classes, etc.)
*
Participant's Signature:
*
Parent's / Guardian's Signature:
*
Submit
Should be Empty: