APPLICANT INFORMATION

Full Name (First, Middle, Last Name)

Birth Date

Month

Day

Year

How did you hear about the program?

Friends

Social Media

Other

Mailing Address (Street, City, State, Zip)

Email

Home Phone

Cell Phone

PARENT/GUARDIAN #1

Type of Guardian

Mother

Father

Other

If Other, please specify

Name (First & Last Name)

Address (Street, City, State, Zip)

Phone

Email

PARENT/GUARDIAN #2

Type of Guardian

Mother

Father

Other

If Other, please specify

Name (First & Last Name)

Address (Street, City, State, Zip)

Phone

Email

EDUCATION (APPLICANT)

Grade and Graduation Year

9th Grade, 2029

10th Grade, 2028

11th Grade, 2027

12th Grade, 2026

School Name

School Address

Current GPA

Future University or College

Anticipated Major or Career Goal

Extracurricular Activities

Please list your current (2025 to present) extracurricular, volunteer, church, hobbies, and work activities in their order of importance to you. Use the space available to provide details of your activities and accomplishments. All school and program acronyms and abbreviations should be spelled out completely to ensure information is transferred accurately. (Please use additional sheets of paper as needed.)

Name of Organization, Start to End Date, Activity positions held, and Honors Received

Essay

The personal essay helps us to become acquainted with you as a person and a student. It will also demonstrate your ability to organize and express your thoughts. Please write an essay (400 words or less, but not less than 200 words) answering one of the questions listed below.

Indicate your topic by checking the appropriate box. Your essay should be typed (12-point Times New Roman), double-spaced, and submitted at a designated date. The Debutante will present her essay at the Debutante Appreciation Banquet that is held after the Scholarship Cotillion.

Topics

If you were the next President of the United States, what would be your first priority?

Describe a major issue within your community and two possible solutions.

Describe a woman in a leadership role who has influenced your life and why.

Acknowledgment of Responsibilities and Participation Agreement

(Parents and applicant must initial their acknowledgment of the statements below.)

During the debutante season, Debutantes may only have two excused absences. The prospective Debutante’s academic and/or extracurricular schedule shall permit active involvement in the Debutante Program.

Parent Initials

Applicant Initials

Debutantes will be asked to solicit sponsorships (through ticket sales and ad sales) from family, friends, and local businesses in support of their participation in this program. I will be able to recruit financial supporters.

Parent Initials

Applicant Initials

Applicant, have you been involved in any criminal incidents at school or in your community within the past 2 years?

Yes

No

If Yes, please explain.

I understand that the Sigma Gamma Rho Sorority Debutante Scholarship Program Cotillion Committee reserves the right to dismiss a Debutante from the program if she does not comply with the attendance policy, becomes disruptive within the program, is disrespectful to the program and its participants, or becomes pregnant or violates any rules of conduct during the debutante season. NOTE: Debutantes dismissed from the program will not receive a refund of any monies paid.

I have provided truthful and complete information in this application and understand the requirements of this program.

Debutante Signature and Date

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My daughter has permission to participate in the Sigma Gamma Rho Sorority. Inc. Debutante Scholarship Cotillion. I understand that participation is voluntary and if my child withdraws at any time the full participation fee and any other monies turned in to the organization is non-refundable. If the Debutante Scholarship Cotillion has to be canceled as a result of a Local, State or National Emergency and/or Health Crisis, participation fee and any monies turned into to the organization is non- refundable, however the Scholarship Committee will designate the amount of scholarship entitled.

Parent Signature and Date

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Application fee

$200

The $200.00 entrance fee covers part of Debutante’s expenses throughout the activities. Payment is due on or before JANUARY 10, 2026, 11:59 PM CST.

SUBMIT APPLICATION BEFORE OR ON (must be timestamped prior to or on NOVEMBER 29, 2025, 11:59 PM CST)

(Only complete applications will be reviewed)