2023-2024 OACDST EMBODI APPLICATION

EMBODI APPLICATION 2023-2024
“The State of the Black Male”

Greetings Potential EMBODI Participants,

This letter is to invite you to participate in an exciting mentoring program for the 2023 - 2024 school year. The Women of the Orlando Alumnae Chapter of Delta Sigma Theta, Inc. are opening our arms and hearts to welcome young men who are interested in joining the

EMBODI (Empowering Males to Build Opportunities for Developing Independence) Program.

EMBODI is a mentorship program that is designed to address educational, social and emotional obstacles young men of color may experience. It brings together young men, between the ages of (11 - 18) years old and in grades (6 – 12), with positive men and women who will serve as mentors for the younger men. Programs activities and events will focus on, but are not limited to, cultural/academic enrichment, building self-confidence, conflict- resolution strategies and any other issues impacting our youth.

Applications must be submitted no later than Saturday, Aug 12, 2023. Please be sure to complete ALL of the forms enclosed in this packet. Failure to submit all parts of the application will exclude you from consideration.

If you have questions or concerns, please feel free to contact Co-chairs:

Cathy Lee-Edwards Clintina Brown Watts Kimberly Hankerson

(407) 719-9444 (407) 963-8501 (407) 247-5223

OR

EMAIL: youthgroups@oacdst.org

Thank you in advance for your cooperation and assistance. We look forward to your participation in the program.

Sincerely,

Isis N. Williams Sherri King

Chapter President Program Planning & Development Chair

EMBODI Program Information
Delta Sigma Theta Sorority, Inc. is a non-profit nationwide organization, whose purpose is to provide service and programs to promote human welfare. 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. EMBODI is designed to refocus Delta’s efforts to collaborate with other established organizations and agencies to address the plight of African American males. The EMBODI program provides a continuum of services and addresses the specific needs of African-American male high school students (ages 14-18) and middle school students (ages 11-14).

Both informal and empirical data suggests that African American males continue to be in crisis and are not successful educationally, socially, and emotionally. EMBODI is designed to address these issues through dialogue, recommended strategies, programs and activities.

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.

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 mission of the EMBODI Committee is to provide young males 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.

EMBODI Participation
Criteria for Participation:

Acceptance into EMBODI is held once a year. The following criteria will be used to determine eligibility:

•        Entering or attending middle or high school in the fall (grades 6-12)

•        Must have a grade point average of 2.5 or better

•        Submit a completed application with a picture

•        Submit one (1) letter of recommendation from one of the following:

o Teacher or Guidance Counselor

o        Employer

o        Minister

o        A Sponsor /Advisor of any affiliation/organization

o        A member of a Greek sorority or fraternity

•        Submit an official copy of 4th Quarter Final Report Card with Final GPA

•        Submit with Parental Signature the “Agreement to Participate”

•        Submit with Parental Signature the “Code of Conduct”

If accepted for participation, you must attend the Student/Parent orientation scheduled for August 19, 2023. The time and location is TBA.

Activities:

The following are potential activities to the organization’s participation:

•         Teen Summits

•         Presentations and Seminars

•         VolunteerHostess/Ushers

•         Black History Month Observance

•         Community Service

•         Academic Testing Workshops, Updates, and Study Sessions

•         Annual Christmas Party, Sleep-over, Parent Appreciation, Field Trips, and

•         End of Year Banquet/Awards Program/Rites of Passage

Code of Conduct:

Participation in EMBODI requires a strong level of commitment and responsibility. All members are to adhere to a “Code of Conduct,” which consists of policies and procedures that governs the organization. The “Code of Conduct” addresses in detail: officers, attendance, participation, academic and disciplinary guidelines, voting, prerequisites for awards and recognition, etc. The “Code of Conduct” will be provided to every member of the program.

EMBODI Important Dates and Deadlines
Application by Saturday, Aug 12, 2023.

•         A completed application and recommendation letters MUST be returned at the time the packet is submitted or you will not be considered for participation.

•         If you have any questions, please contact the current Delta EMBODI Chair – Cathy (407) 719-9444.

•         You may also send an email: youthgroups@oacdst.org.

If selected for participation:

All participants MUST attend the Student/Parent Orientation currently scheduled for August 19, 2023. The location is TBA. Participants should wear professional business attire and have at least one parent, guardian or family member present to receive information and fill out any additional paperwork.

If selected to become a member of EMBODI sponsored by Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc., I understand and agree to the following guidelines and expectations:

1.       Participation in the Student/Parent Orientation and Ceremony is mandatory.

2.       Involvement and participation in all EMBODI activities are governed under the auspices of Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc., EMBODI Code of Conduct, Officers, and Committee Chairpersons.

3. Participation is strictly voluntary and requires a strong level of commitment.

4. Members in good standing may continue participation until high school graduation.

5.       Attendance at all regularly scheduled meetings (currently the second Sunday of each month starting in September from 2:00 p.m. — 4:00 p.m, occasional midweek workshops/community service) and other planned activities is expected.

6.       A 2.5 or better grade point average will be required and maintained. Note: All applicants must improve their GPA by 0.5 points by the end of the school year to be invited to return to the program for the 2023 -2024 school year.

7.       Appropriate behavior becoming of a young man should be exemplified at all times. PLEASE KEEP THIS AND THE PRECEDING PAGES FOR YOUR OWN INFORMATION.

Section 1: Applicant Information
Student Name*

First NameMiddle Name or InitialLast Name
Student Age, as of 7/1/2023*
Student Date of Birth*

MonthDayYear
Date
Address (include apartment number, city, state and zip code)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student home phone
Please enter a valid phone number.
Student cell phone
Please enter a valid phone number.
Student Email
example@example.com
Student T-shirt Size*
Church Affiliation
Middle School or High School Name*
Grade for the 2023-2024 school year*
GPA
Are you a participant in the free/reduced lunch program?*

YESNO
This will be my ____ year participating in the Orlando Alumnae Chapter Delta EMBODI program.

1st2nd3rd4th5th6th7th
How did you hear about the program?

Parent/Guardian Information
Parent/ Guardian Name (First, Last)*

First NameLast Name
Parent/Guardian Home Number
Please enter a valid phone number.
Parent/Guardian Work Number
Please enter a valid phone number.
Parent/Guardian Cell Number *
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com

Personal Information
Is your mother a member of Delta Sigma Theta Sorority?

YesNo
Have you participated in any other EMBODI program?

YesNo
Do you currently have a sibling participating in an EMBODI program?

YesNo
If yes, please give name:
Have you participated in any Delta Sigma Theta sponsored activities?

YesNo

Section 2: Applicant Questions
What are your favorite and least favorite subjects? Explain why.
Describe your strengths and areas for development.
What are your future goals after graduation?
List all extracurricular or after-school activities
Do you have any hobbies and/or interests? If so, describe.
Why do you want to be a participant in EMBODI ?
Signature of Applicant

Clear

Section 3: Applicant Essay
Upload a typed, 250-500 word essay (include your name and a title): In your opinion, what is a significant issue or development that is positively or negatively affecting your generation? How will your participation in a program, such as EMBODI, enable you to confront or contribute to this issue or development?

Section 4: Transportation Information
How will your child travel to and from EMBODI meetings and activities? (Please Note: The Delta Sigma Theta Sorority, Inc. Orlando Alumnae Chapter does not provide transportation and is not responsible for your child’s travel to or from the EMBODI program.)

CarWalkPublic TransportationOther
Do you have any additional persons (other than parent/guardians & emergency contacts listed on this form) who are approved to transport your child? If yes, please list (this may include a sibling, grandparent, family friend, etc.):
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.
Name

First NameLast Name
Relationship
Phone Number
Please enter a valid phone number.

Section 4: Emergency Contact Information

TWO contacts MUST be provided
Name*

First NameLast Name
Relationship*
Home Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Name*

First NameLast Name
Relationship*
Home Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.

Section 6: Authorization for Medical Treatment
PARENT AUTHORIZATION FOR MEDICAL EMERGENCY TREATMENT

In case of medical emergency, I understand every effort will be made to contact parents or guardian of the child. In the event I cannot be reached, I hereby give permission to the physician selected by authorized representative(s) of the Orlando Alumnae Chapter to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child.
Student Name

First NameLast Name
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Section 7: Consent Forms
STUDENT/PARENT AGREEMENT TO PARTICIPATE

We have read and agree with all the information provided for the EMBODI program sponsored by the Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc. If (our/my) child is selected for participation into the EMBODI program, please accept (our/my) signature(s) as (our/my) consent to have him participate. You may count on (us/me) for support and assistance whenever appropriate.
Student Name

First NameLast Name
Student Signature

Clear
Date

MonthDayYear
Date
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
PARENT/GUARDIAN STATEMENT OF CONSENT

I voluntarily give my son (the student whose name is listed above) permission to participate in the EMBODI program. I am authorized to give permission for the student to participate in the program. My child’s participation in the EMBODI program is completely voluntary. EMBODI is committed to providing the best possible climate for maximum development and achievement of goals for all student participants. The Delta Sigma Theta Sorority, Inc. Orlando Alumnae Chapter and its related entities will make every effort to protect the welfare of the EMBODI participants; however, the program committee members are not responsible for ensuring the physical, mental, social and medical health of program participants. As a parent/guardian, I am responsible for the welfare of my child. The EMBODI committee may suspend a student’s participation if their behavior does not reflect the spirit of the program.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
CONSENT TO PHOTOGRAPH

I voluntarily give permission for my son (the student whose name is listed above), to be photographed and videotaped. My signature gives consent to the use of his likeness in any publication, educational material, advertising, news media, and World Wide Web materials that the EMBODI/Orlando Alumnae Chapter may utilize and produce. I understand and agree that such materials, including all negatives, positives, digital images, and prints shall become and remain the sole property of the EMBODI/Orlando Alumnae Chapter and I shall have no right or title to such items. I further understand and agree that these materials may be kept on file and used by the EMBODI/Orlando Alumnae Chapter for potential future use. I agree to release the EMBODI/Orlando Alumnae Chapter from any and all liability arising from or in connection with the taking, use, publication, or dissemination of such materials. Copies of these photos may be distributed to the parent upon request.
Parent /Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Section 7: Consent Forms Cont'd
WORKSHOP PERMISSION

I grant permission of my son {studentName32} , to participate in the workshops presented to the participants of the EMBODI program sponsored by the Orlando Alumnae Chapter. I understand that most of the workshops are listed in the EMBODI/Orlando Alumnae Chapter yearly calendar.
If you have any objectionable topics, please list them and sign below:
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date
FIELD TRIP PERMISSION

As the parent/guardian of, {studentName32} , I hereby give consent for him to attend field trips with EMBODI Program sponsored by the Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc.

My son and I understand that he is to comply with all rules and regulations established by all representatives of Delta Sigma Theta Sorority, Inc.

I understand that precautions will be taken to ensure my son’s safety. I, therefore, will not hold the Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc. or any representatives of Delta Sigma Theta Sorority, Inc. responsible for any complication, injury, or illness experienced by my son.

Field trips are subject to change, and notification is at the discretion of Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc.
Parent/Guardian Name

First NameLast Name
Parent/Guardian Signature

Clear
Date

MonthDayYear
Date

Picture, Letter of Recommendation, and Transcript Uploads
Please upload a recent picture. The picture will help us get to know and identify the participants prior to our first session. It is important to us that we know each young man by name and face early in the program.
File Upload

Cancelof
Request (1 )Letter of Recommendation from any of the following:

- Teacher or School Counselor
- Employer
- Minister/Church leader
- A Sponsor/advisor of any affiliation/organization
- A member of a Greek sorority or fraternity

Once you submit their name and email they will receive your request to submit a letter of receommendation on your behalf. Please notify them in advance of your request!
Recommender

First NameLast Name
Email of Recommender
example@example.com
Upload an official copy of your 4th quarter report card. An unofficial transcript with current GPA from your guidance counselor may be used too. We must be able to see your name and GPA within the upload.
File Upload

Cancelof

Section 8: EMBODI Code of Conduct Statement
I will cooperate with all adults in charge. I will be sensitive to the needs of the each participant.

I will respect the people and places with which I come in contact. I will adhere to the EMBODI dress code.

I will participate in required activities & discussions, be on time for all scheduled activities, and be open to new ideas. In the event I must miss an event, I will contact a member of the EMBODI Committee at least 24 hours ahead of the activity.

I understand that obscene language and the use of alcohol, tobacco, and illegal or unauthorized drugs, and fighting will not be tolerated. Such usage during the activity may result in immediate dismissal from the program.

I will remember that I am a member of a program sponsored by the women of Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc. and I must abide by a high standard of conduct. My behavior will reflect the high values and expectations described in this code of conduct and gentlemen like etiquette.

I will be responsible for all my personal belongings.

I understand that I will receive two warnings for unacceptable behavior. After two warnings, my parent/guardian may be notified. I understand if I am sent

home early due to any misconduct, it will be my parent’s responsibility to provide transportation regardless of the time of day or night. I also understand that any additional costs for transportation will be my parent’s responsibility.

I understand that more than (2) absences may result in me being dropped from the program and may also prohibit me from being able to participate on any field trips.

I understand that my attitude and behavior are central to the success of this activity sponsored by the Orlando Alumnae Chapter of Delta Sigma Theta Sorority, Inc.

Therefore, for the good of this activity, as well as for myself and my fellow group members, I agree to abide by the statements above:
Signature

Clear
Date

MonthDayYear
Date
As the parent/guardian, I understand and agree with the above responsibilities fully accepted by my son Should it be necessary, I will provide transportation for my son regardless of the time or day or night. I will not hold Orlando Alumnae Chapter or its members responsible if my son is sent home early due to misconduct.
Signature

Clear
Date

MonthDayYear
Date

THE CONTRACT (The First Meeting)
OAC EMBODI

I will respect everyone else’s privacy.

There is to be no teasing or prying.

Each individual has the right to decide whether to share private thoughts during EMBODI meetings or discussions.

Anybody who wants to simply sit and listen may do so, with the understanding that participation is beneficial but voluntary.

I will show everyone respect.

There will be no teasing or scolding. The idea is for the whole group to arrive at its goals, but each individual will progress at a different rate.

I will uphold the family confidentiality.

There will be no telling.

What happens and what is said within the group stays within the group.

Group members should feel free to discuss their thoughts and feelings knowing they need not feel bashful or shy, or worry that friends or people outside the

group will find out things they’d rather keep private.

I will trust my group members.

There will be no blaming and no lying.

I promise to make my best effort to be honest, accepting that no one is perfect and everyone makes mistakes from time to time.

I will show up on time for group meetings and activities.

I will complete all my homework assignments.

I will listen to others without interrupting.

I will be positive and try to encourage everyone in my group.

If you agree to all of the above, sign below.
Student Name

First NameLast Name
Student Signature*

Clear
Date

MonthDayYear
Date
Should be Empty:

EMBODI APPLICATION 2023-2024

EMBODI Program Information

EMBODI Participation

EMBODI Important Dates and Deadlines

Section 1: Applicant Information

Parent/Guardian Information

Personal Information

Section 2: Applicant Questions

Section 2: Applicant Questions cont'd

Section 3: Applicant Essay

Section 4: Transportation Information

Section 4: Emergency Contact Information

Section 5: Applicant Health Information

Section 6: Authorization for Medical Treatment

Section 7: Consent Forms

Section 7: Consent Forms Cont'd

Picture, Letter of Recommendation, and Transcript Uploads

Section 8: EMBODI Code of Conduct Statement

THE CONTRACT (The First Meeting)