Delta Sigma Theta Sorority, Inc s4

Henry County Alumnae Chapter Delta Sigma Theta Sorority, Inc.

Academy GEMS EMBODI

Application Instructions 1. This is a Word Doc file. This will allow you to fill-in the application via computer, then print and sign so that we can receive a legible copy. 2. Make sure that you submit a complete application. Incomplete applications may affect possible participation in the program. 3. Application must be signed with an original signature. The Application must be signed by both the parent and youth. 4. Please note if there is more than one application in your packet. 5. This packet will require extra postage. Please keep your receipt and a copy of the application for your records.

MANDATORY MONTHLY WORKSHOPS WILL BE HELD ON THE FIRST SATURDAY OF EACH MONTH STARTING OCTOBER 7, 2017

PARENTS: WE ALSO HAVE PARENT WORKSHOPS HELD AT THE SAME TIME OUR YOUTH WORKSHOPS ARE HELD, SO FEEL FREE TO JOIN US WHILE YOUR CHILD PARTICIPATE IN THE YOUTH WORKSHOP.

 MANDATORY ORIENTATION/KICKOFF: SATURDAY, SEPTEMBER 9, 2017

Youth are expected to attend all workshops. If three workshops are missed, the youth will be discontinued from the program. Interviews may be conducted prior to acceptance in the program. Completed and signed application must be received / postmarked by May 15, 2017 to: Delta Sigma Theta Sorority Inc., Henry County Alumnae Chapter Attn: EDUCATIONAL DEVELOPMENT P.O. Box 787 McDonough, GA 30252

Or email to [email protected]. For questions or additional information, please contact Donna Tebought at [email protected] or (678) 232 - 2744. Participant Application

Please select one program of interest and complete one application per participant: Delta Academy Delta GEMS EMBODI

Girls: Middle School Girls: High School Boys: Middle & High School

Youth Personal Information Name: ______Date of Birth: ______Address: ______City: ______State: ______Zip: ______Home Phone: ______Cell Phone: ______E-mail Address: ______

Shirt Size (adult): ____Small ____Medium ____Large ____Extra Large____2XL-4XL

Parent Personal Information Parent(s)/Guardian(s) ______Home Phone: ______Cell Phone: ______E-mail Address: ______

Is parent a member of Delta Sigma Theta Sorority, Inc.? Yes No

Returning participant: Yes____ No ______Henry County Resident: Yes____ No ______Single Parent Household: Yes____ No ______Child 1st generation college: Yes____ No ______Child receives free/reduced lunch: Yes____ No ______

Have you ever been expelled from school Yes_____ No___

Have you ever been arrested Yes___ No___ Why do you want to be involved with the program? What do you hope to gain or learn by participating in this program? ______Please list extra-curricular activities/hobbies in which you participate (indicate offices held, if applicable). You may attach a sheet to the application if more space is needed. ______

Is there anything that you consider special or unique about yourself that you would like to share? Please explain. ______

Please place a check by each topic(s) that may be of interest to you: ______African-American Culture/History ______Positive Self Image ______Career Information/Exploration ______Proper Nutrition/Fitness ______College/Trade School ______Public Speaking ______Community Service ______Resume Writing ______How to Dress ______Science ______Job Interviewing ______Study Skills/Time Management ______Outdoor adventures ______Technology ______Other (educational or social) Please specify: ______What new subject would you like to learn about? ______SCHOOL INFORMATION Name of Current School: ______School Address: ______Principal’s Name: ______Counselor’s name: ______Grade Level for 2017-2018: ______Honors and Awards (including Honors/AP Classes): ______Career Goal: ______How did you hear about the program? ______

Statement of Applicant

I hereby state that the information on this application is true and complete. I hereby agree to make the necessary commitment to attend as well as participate in each scheduled session/activity for this program.

Applicant Signature: ______Date: ______

Parent(s)/Guardian(s): Signature: ______Date: ______The Dr. Betty Shabazz Delta Academy Program Information The DELTA Academy was created out of an urgent sense that bold action was needed to save our young females from the perils of academic failure, low self-esteem and crippled futures. The DELTA Academy's aim is to shape well rounded young women by focusing on African American history, literacy, character development, healthy choices and service learning. Many young ladies have tremendous potential, however they are not afforded the opportunity to broaden themselves, express their curiosity, and experience new and different things early on.

The goals for DELTA Academy are:  To promote scholarship in math, science and technology and/or careers where minority women are scarcely represented;  To increase their opportunities to provide service in the form of leadership;  To promote sisterhood defined as the cultivation service learning; and  To promote sisterhood defined as cultivation and maintenance of relationships. Dr. Jeanne L. Noble Delta G.E.M.S Program Information The DELTA G.E.M.S. (Developing Effective Leadership Through Achieving, Growing, Empowering Myself Successfully), was established as an extension of the Dr. Betty Shabazz Delta Academy I program. The objective of the DELTA G.E.M.S. program is to serve as a motivational tool which targets female teenagers in an effort to increase knowledge and awareness of issues and concerns that affect young women in our society today. The mission of the DELTA G.E.M.S. is to provide young ladies with a firm structural program that will enhance their self-esteem, academic achievement, leadership skills, and cultural awareness. This, in turn, will provide them with the opportunity to develop emotionally, socially, and intellectually and be prepared to take an active role in their success as they face the challenges of the world.

The goals for DELTA G.E.M.S. are:  To promote positive societal interactions;  To develop effective written and oral communication skills;  To encourage self-confidence, self-motivation, and self-discipline;  To foster meaningful public service; including mentoring and networking;  To strive for intellectual enrichment;  To assist with the exploration of various career paths and means for obtaining them (college and/or vocational skills training);  To support talents in academics, technology, sports, and fine arts; and  To maintain moral values and personal pride while experiencing the crossroads of life. EMBODI Program Information Empowering Males to Build Opportunities for Developing Independence (EMBODI) is the signature program of Delta Sigma Theta Sorority, Inc.’s 24th National President, Cynthia M.A. Butler-McIntyre. The EMBODI program provides a continuum of services and addresses the specific needs of African-American male high school and middle school students. The EMBODI Program serves as a motivational tool for African American teenage males with the ultimate goal of increasing their knowledge and awareness of issues affecting young men today.

The goals of EMBODI are:  To expand the horizons of young African American males by cultivating a personal vision for their lives;  To provide tools for young African American males to attain a higher quality of life;  To provide young African American males with an awareness of various college and career options to make rewarding life choices and decisions; and  To create community-minded young African American males by actively involving them in service learning and community service opportunities.