Teach for America Application

Teach For America Corps Region (where you will teach this fall)*

First Name*

Middle Name

Last Name*

Email Address*

Enter Email Confirm Email

**A confirmation email will be sent to this email address**

PLEASE ENTER YOUR PERMANENT STREET ADDRESS INFORMATION BELOW:*

Street Address City State ZIP Code

Primary Phone*

Formatting should be ###-###-####

Secondary Phone

Social Security Number*

Formatting should be ###-##-####

Birth Date*

Legal Sex*

State of Residency*

Select your State of Residency

Citzizenship*

To accurately respond to requests from a variety of federal, state, and community entities, DSU asks you to answer the following questions:

For reporting purposes, do you identify as a member of the Latinx community?

Yes
No
I prefer not to answer

For reporting purposes, with which of the following races do you most closely identify? You may select more than one category.

American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
I prefer not to answer

I hereby submit my application for admission to Delta State University and I agree to abide by the regulations of the University and to accept responsibility for payment of all charges incurred while I am a student. I further declare that the information on this application is complete and accurate. Delta State University is committed to a policy of equal employment and educational opportunity for all persons without regard to race, color, religion, national origin, sex, physical or mental handicap, status as disabled veteran or Vietnam era veteran, or age as specified by applicable laws and regulations. This policy extends to all programs and activities supported by the University.

NOTE: Teach for America Corps Members will be assessed a charge of $266 in exchange for 9 graduate credit hours from Delta State University. This cost will cover registration, tuition, and official transcript fees. For any questions regarding this amount, please contact your placement region. Detailed payment instructions will be communicated to all participants no later than July 1, 2021.

Signature*

First Last

Signature Date

Admissions Documents

Delta State must maintain on file or have access to the transcript from the institution where your undergraduate degree was awarded. To make this process easier, Delta State can access your transcript that is on file with TFA. To do so, please initial the statement below.

Initials*

I give Delta State University permission to share a copy of my official Delta State University transcript with Teach for America upon request by Teach for America.

If you have any questions about your enrollment, please contact the University Credits project owner in your regional Teach For America office.

Teach for America Summer Institute

Admissions Documents

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