Youth Initiative Application 2020

Dear Parent/Guardian:

The Stone Mountain-Lithonia Alumnae Chapter of Delta Sigma Theta Sorority Incorporated invites your son and/or daughter to participate in one of our three youth initiatives.

To participate in one of our extraordinary programs, please complete the following application. For the application to be considered, all requested information and signtures should be completed.

Applications are due by July 3, 2020 at 11:59pm.

If there are any questions, please do not hesitate to email them to: educationaldevelopment@smlacdst.org.

Sincerely,

Dennette Battle, President

Jessica Fields, Chair - Educational Development

Shavone Smith, Co-Chair - Educational Development

Youth Initiative Program of Interest (Read Carefully & SELECT ONE)

Returning from 2019 - 2020 Year?

Select One:

Student Name

First NameLast Name

Age

Grade for 2020 - 2021 School Year

Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Home Phone Number

Area CodePhone Number

Student Cell Phone Number

Area CodePhone Number

Student Email

example@example.com

School Name (Please give FULL name and not an abbreviation)

School City

School County

T-shirt Size (Best efforts will be made to provide the size selected. Some vendors do not offer certain sizes).

Extra-Curricular Activities:

Talents: (What do you do best?)

What do you want to gain from participating in the Youth Initiative Program?

What subject(s) would you like to learn about or are you interested in?

Parent/Guardian #1 Name

First NameLast Name

Parent/Guardian #1 Home Phone Number

Area CodePhone Number

Parent/Guardian #1 Cell Phone Number

Area CodePhone Number

Parent/Guardian #1 Email

example@example.com

Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian #2 Name

First NameLast Name

Parent/Guardian #2 Phone Number

Area CodePhone Number

Parent/Guardian #2 Cell Phone Number

Area CodePhone Number

Parent/Guardian #2 Email

example@example.com

Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Emergency Contact Name (If parent/guardian is not available):

First NameLast Name

Emergency Contact Home Phone Number

Area CodePhone Number

Emergency Contact Cell Phone Number

Area CodePhone Number

Emergency Contact Email

example@example.com

Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Relationship

Please upload parental/guardian consent form, if you have it available. If you do not have the form, one will be provided following the application submission.

Browse Files

Youth Initiative Application 2020 - 2021