Delta GEMS and Academy Application Form

Delta GEMS and Academy Application

2025 - 2026
Dear Parent/Guardian:

The Mississippi Gulf Coast Alumnae Chapter of Delta Sigma Theta Sorority Incorporated invites your daughter to participate in one of our two youth initiatives.

To participate in one of our extraordinary programs, please complete the following application. For the application to be considered, all requested information and signatures should be completed.

If you have any questions, please don't hesitate to email them to mgcacpresident@gmail.com.

Sincerely,

Searcy Taylor, President

Linda Anderson, Delta GEMS Chair

Venita Goins, Delta GEMS Co-Chair
Youth Initiative Program of Interest (Read Carefully & SELECT ONE)

Delta GEMS - Females 9th to 12thDelta Academy -Females 6th to 8th
Returning from 2024 - 2025 Year?

YesNo
Age
Student Name

First NameLast Name
Grade for 2025 - 2026 School Year

6th Grade7th Grade8th Grade9th Grade10th Grade11th Grade12th Grade
Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Home Phone Number

Area CodePhone Number
Student Cell Phone Number

Area CodePhone Number
Student Email
example@example.com
School Name (Please give FULL name and not an abbreviation)
Extra-Curricular Activities:
T-shirt Size (Best efforts will be made to provide the size selected. Some vendors do not offer certain sizes).
Talents: (What do you do best?)
What do you want to gain from participating in the Youth Initiative Program?
What subject(s) would you like to learn about or are you interested in?
Parent/Guardian #1 Name

First NameLast Name
Parent/Guardian #1 Home Phone Number

Area CodePhone Number
Parent/Guardian #1 Cell Phone Number

Area CodePhone Number
Parent/Guardian #1 Email
example@example.com
Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian #2 Name

First NameLast Name
Parent/Guardian #2 Phone Number

Area CodePhone Number
Parent/Guardian #2 Cell Phone Number

Area CodePhone Number
Parent/Guardian #2 Email
example@example.com
Parent/Guardian #2 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name (If parent/guardian is not available):

First NameLast Name
Emergency Contact Home Phone Number

Area CodePhone Number
Emergency Contact Cell Phone Number

Area CodePhone Number
Emergency Contact Email
example@example.com
Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship
Please upload parental/guardian consent form, if you have it available. If you do not have the form, one will be provided following the application submission.

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