JABBERWOCK PROGRAM APPLICATION

*Deadline is November 15, 2014

Sponsored By:

The Brazos Area Alumnae Chapter

of Delta Sigma Theta Sorority, Incorporated

ELIGIBILITY AND REQUIREMENTS

Applicants must be young ladies/young men in the Class of 2015, 2016 and 2017.

Application requirements:

  1. Application must bepostmarked and mailed nolater than November 15, 2014.

Mailing Address: Delta Sigma Theta Sorority, Inc.

Brazos Valley Area Alumnae Chapter

Attn: Jabberwock Program

P.O. Box 2222

Bryan, Texas 77806

  1. Participants selected will be notified via phone call by November 19thand required to attend the Orientation and Kick-off Meeting on November 22nd at 1:00 pm, at the Lincoln Recreation Center in College Station, where they will each meet the Jabberwock Committee.
  1. Participants will be required to pay anon-refundable $25 fee at this time. Cash and checks will be accepted. Please make checks payable to Brazos Valley Area Alumnae Chapter.

The Jabberwock Pageant date is slated for April 11, 2015.

The theme for this event is:“Harlem Nights”

For additional information, please contact the following:

Ms. D. Lenea Banksand/orMs. Jessica Pierce, Jabberwock Co-Chairpersonsat the email address

THE BRAZOS VALLEY AREA ALUMNAE CHAPTER OF

DELTA SIGMA THETA SORORITY, INCORPORATED

JABBERWOCK APPLICATION

Type or print in black ink.

PERSONAL INFORMATION

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Last Name First Name Middle Initial

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Date of Birth (MM/DD/YY) Email Address

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Address (No. & Street) Apt. # City State Zip Code

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Primary Phone Number Alternate Phone Number

Parent/Guardian’s Name ______

EMERGENCY CONTACT INFORMATION

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Name Relationship Phone

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Address (No. & Street) Apt. # City State Zip Code

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Name Relationship Phone

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Address (No. & Street) Apt. # City State Zip Code

ACADEMIC INFORMATION

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Present High School Grade/Class

Student Involvement:

School-Related Activities Positions Held

______

______

______

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Honors/Awards/Accomplishments

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______

______

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Special Talents and Hobbies

______

______

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Church & Community-Related Positions Held

Services and Activities

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______

______

I affirm that all statements made in this application are true.

Applicant Signature: ______Date: ___/___/___

Parent/Guardian Statement:

If selected, I grant permission for my son/daughter, ______, to participate in the Jabberwock 2014-15Program. I authorize Delta Sigma Theta Sorority, Inc. a medical power of attorney in case of emergency.

My son/daughter has the following medical problems:

______.

I understand that there is a$25 non-refundable application fee that will be submitted at the Orientation and Kick-off event on November 22, 2015, and respectfully understand the commitment (rehearsals, service projects, etc.,) involved in the planning and presentation for the success of this event.

I understand that my son’s/daughter’s participation will be a memorable experience for him/her. I agree to support my son/daughter morally and financially in all endeavors.

______

Parent Signature Date