Delta G.E.M.S 2021-2022 Application

DELTA SIGMA THETA SORORITY, INC.
2021 -2022

DELTA G.E.M.S APPLICATION

SPONSORED BY

TALLADEGA COUNTY ALUMNAE CHAPTER

Confidentiality Statement The information provided in this application will be used for statistical and reporting purposes. None of this information will be disseminated to the public and will be treated as confidential by the Delta G.E.M.S. Committee.

DR. JEANNE L. NOBLE G.E.M.S.

“GROWING & EMPOWERING MYSELF SUCESSFULLY”

Dear Prospective Delta G.E.M.S.:

Thank you for your interest in our esteemed program to assist young ladies growing and empowering themselves successfully. The Dr. Jeanne Noble Delta G.E.M.S. program is an extension of the Dr. Betty Shabazz Delta Academy program. Delta G.E.M.S. was created to “catch th the dreams” of adolescent girls aged 14-18 and/or grades 9-12. Delta G.E.M.S. provides the framework to actualize those dreams through the performance of specific tasks that develop a “CAN DO” attitude. The goals for Delta G.E.M.S.:
- To instill the need to excel academically
- To enhance the girls skills to achieve high levels of academic success
- To assist girls in proper goal setting and planning for their futures, including high school and beyond; and
- To create compassionate, caring and community minded young women by actively involving them in service learning and community service opportunities
The G.E.M.S. framework is composed of eleven major components, forming the road map for college and career planning. Topics within these components are designed to provide interactive lessons and activities that provide opportunities for self-reflection and individual growth. The components are:

    Self-Awareness          Skills for Success        Leadership Development

    Socialization           Healthy Lifestyle Habits         Financial Preparation

Financial Achievement     Educational Preparation          Career Preparation

For consideration into the Delta G.E.M.S. program, all applicants must complete the provided application. All application components must be submitted online or postmarked by December 3rd, 2021. Space is limited and late applications will not be considered. Only accepted applicants into the Delta G.E.M.S. program will be notified by phone and/ or email. The Delta G.E.M.S. program is scheduled to meet once per month beginning in January, and during the Delta G.E.M.S. Member & Parent Orientation. The remaining subsequent meetings and activities will be held at pre-selected meeting locations.

Like a gemologist, who can see through the use of certain tools, the hidden treasure in unpolished jewels, the Delta G.E.M.S. logo uses the polished jewels as a symbol of the many facets that shine and glow within our young African-American women. Thank you again for your interest into Delta GEMS and we look forward to building lifetime relationships and implementing exemplary programs.

Please submit online or mail all components of the completed application in one envelope to:
Talladega Alumnae Chapter

Delta G.E.M.S

Delta Sigma Theta Sorority, Inc.

PO Box 1323

Sylacauga, AL 35150

Applications postmarked or submitted online after DECEMBER 3RD, 2021 will not be reviewed.
Eligibility Requirements
All participants must meet the following criteria:

_____ Submit a completed Delta G.E.M.S. application which includes completing all forms, only completed applications postmarked or submitted online by December 3rd, 2021 will be reviewed.

_____ Submit all mandatory forms

_____ Attend parent/youth orientation

_____ Display consistent attendance at monthly meetings and scheduled activities

_____ Display a positive attitude and follow the guidelines as set forth by the Delta Sigma Theta Sorority. Incorporated Youth Code of Conduct

Contact Information

Please contact the Delta G.E.M.S Committee Chair for additional Information:

Gina Holland

Email: rgholland24@earthlink.net

Phone: 256.493.8175

This will be my ___ year participating in the Delta G.E.M.S program?*

1st2nd3rd4th
How did you hear about the program?*
Parent or Guardian Information:
Parent(s)/Guardian(s) Name*

First NameLast Name
Home Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Parent(s)/Guardian(s) Cell Number
Please enter a valid phone number.
Parent(s)/Guardian(s) E mail*
example@example.com
EMERGENCY CONTACT INFORMATION
In the event of an emergency (Please list two):
Name:*
Name*

First NameLast Name
Relationship:*
Emergency Number*
Please enter a valid phone number.
Alternate Contact Number
Please enter a valid phone number.
Emergency Number:*
Alternate Contact Number:*
Name:*
Name

First NameLast Name
Relationship:*
Emergency Number*
Please enter a valid phone number.
Alternate Contact Number
Please enter a valid phone number.
Personal Information:
Is your mother a member of Delta Sigma Theta Sorority, Inc.?*

YESNO
Have you participated in any other Delta G.E.M.S program?*

YESNO

Do you currently have a sibling participating in a Delta G.E.M.S program?*

YESNO
If yes, please give name
Have you participated with Delta Academy?*

YESNO
Have you participated in any Delta Sigma Theta sponsored activities {i.e., Jabberwock, etc.)?*

YESNO
Have you participated in any Delta Sigma Theta sponsored activities {i.e., Jabberwock, etc.)?*

YESNO
APPLICANT QUESTIONS
What is your favorite and least favorite subjects? Explain why.*
Describe your personal strengths and challenges.*
What are your future goals after graduation? Do you plan to attend college?*
Do you participate in extracurricular or after school activities/sports? If so, describe in detai the activity and how much time you spend on that activity.*

SIGNATURE OF APPLICANT*

Clear
Date*

MonthDayYear
Date
SIGNATURE OF PARENT/GUARDIAN*

Clear
DATE*

MonthDayYear
Date
Should be Empty:

Eligibility Requirements

APPLICANT INFORMATION

Participant Information

Parent or Guardian Information:

EMERGENCY CONTACT INFORMATION

Personal Information:

APPLICANT QUESTIONS