DCAC Educational Development Registration

DCAC Educational Development Registration 2026-2027

Delta GEMS & Delta Academy
- Participant Name
  
  First NameLast Name
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Which program will you be registering for this year?
- Mailing Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Email Address
  example@example.com
- Cell Phone
  
  Area CodePhone Number
- Alternate Phone
  
  Area CodePhone Number
- What school do you attend?
- Grade level for the 2023-2024 school year
- Grade level for the 2025-2026 school year
- What is your strongest academic subject?
- What is your weakest academic subject?
- What are your extracurricular activities for the 2025-2026 school year?
- List any honors and awards (including Honors/AP classes for high school students)
- What is your career goal?
- List all non-school related organizations and clubs to which you belong:
- List the community service projects in which you participate during the school year:
- What are your hobbies?
- List your special talents and skills:
- What, if anything, would prevent you from fully participating in the Delta Academy or Delta GEMS Saturday sessions?
- How did you hear about the Delta Academy/GEMS program?
  
  Other
- Mother/Guardian's Name
  
  First NameLast Name
- Mother/Guardian's Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Mother/Guardian's Phone Number
  
  Area CodePhone Number
- Mother/Guardian's Email
  example@example.com
- Father /Guardian's Name
  
  First NameLast Name
- Father/Guardian's Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Father/Guardian's phone number
  
  Area CodePhone Number
- Father/Guardian's Email Address
  example@example.com
- Please attach a copy of your most recent report card as proof of a minimum 2.0 cumulative G.P.A.
  
  Browse Files
  
  Cancelof
- If you have any questions and/or comments, please contact us via email at dcac.educationaldev@gmail.com
- Applicant Signature
- Should be Empty:

DCAC Educational Development Registration 2026-2027

Delta GEMS & Delta Academy