2024-2025 College Tour Application

Dear Students and Parents,
We are excited to invite students to apply for participation in the Covington Area Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated Next Level College Tour 2024-25. The purpose of the College Tour Program is to provide high school students in Newton and Walton Counties with the opportunity to visit institutions of higher learning. Students will gain early exposure to campus life in an effort to pique interest in post-secondary college and career opportunities and to assist them with making informed decisions about college and career choices.

High school students in Grades 9-12 are eligible and encouraged to apply. The CollegeTour is a two phase experience spanning over 5 months and culminating in a power packed tour of colleges and universities on February 15-17, 2025. The planned schedule of schools to visit (subject to change) includes: Athens Technical College, Belmont University, Clark Atlanta University, Fisk University, Meharry Medical College, Tennessee State University, University of Georgia, and Vanderbilt University. There are two phases to this initiative:
- Phase I: Mandatory Pre-Tour Monthly Workshops (October – January)
- Phase II: 3 Day/ 2 Night College Tour (February 15-17, 2025)
The cost of this year’s program is $400. This price covers motor coach
transportation, lodging, select meals on the trip, snacks during workshops,
commemorative t-shirts and a resource binder.

Application requirements are outlined on the following pages. Completed applications should be received at collegetour@caacdst.org by Friday, October 18, 2023.

We look forward to sharing more information with you and meeting you. In the
meantime, the college tour committee may be reached at collegetour@caacdst.org to answer and address any questions.

Respectfully Yours,

Barbara Collins, Covington Area Alumnae Chapter President

Derykka Miller, CAAC Chair, Educational Development

Natalie Davis, CAAC College Tour Chair, Educational Development

Parent Information
Parent/Guardian Name*

First NameLast Name
Relationship to Applicant*

MotherFatherLegal Guardian
Address (if different from Applicant)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent Email
example@example.com
Phone Number
Please enter a valid phone number.
Cell Phone Number*
Please enter a valid phone number.
Work/Alternate Phone Number*
Please enter a valid phone number.
Emergency Contact*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Relationship*
Student medical history and authorization

Medical Insurance Coverage is mandatory for ALL tour participants. In case of an emergency necessitating medical treatment of the college tour participant by a hospital, physician, and/or emergency responder, the insurance information provided will be used.
Name of Tour Participant *

First NameLast Name
Name of Insured (primary policy holder)*

First NameLast Name
Relationship to Tour Participant*
Carrier*
Policy ID #*
Employer/Group*
Group #*
Signatures
I parent/guardian's name* , under penalty of perjury, do hereby affirm to the Covington Area Alumnae Chapter of Delta Sigma Theta Sorority, Inc. that I authorize the participation of child's name* in the Youth Initiative Program (CAAC Next Level College Tour 2024-2025), and that I have the legal authority to provide my consent and authorization for such participation. I affirm that the information provided on this form is complete and accurate to the best of my knowledge. I further affirm that I understand the behavioral expectations associated with this process, as well as any possible consequences for non-compliance with discipline policies and procedures. I am aware that consequences for discipline infractions may include, but are not limited to dismissal from the program or any of its components and/or the loss of any financial investments made there to. I understand that transportation to and from the mandatory monthly workshops is the sole responsibility of the parent(s)/guardian(s) and is not covered by the associated fees. I also understand that sessions may be recorded/ videotaped and/or photographed and portions of the materials obtained may be used for promotional, advertising, educational, and/or any other lawful purposes. I therefore release and waive any claims or rights of compensation or ownership
regarding such uses and understand that all such recordings shall remain the property of the chapter. Lastly, understanding that reasonable precaution/care will be taken to safeguard my child during this process, I will not hold the Covington Area Alumnae Chapter of Delta Sigma Theta, Sorority, Inc., any of its members, or any authorized chaperones responsible for any accidents or losses that may occur. I waive, release, and discharge all claims for personal and property damages arising out of my child's participation in the Youth Initiative Programs. I hereby give my permission for my son/daughter to participate in the Youth Initiative Program (CAAC Next Level College Tour 2024-2025).
Signature of Parent/Legal Guardian: *

Clear
Date*

MonthDayYear
Date
Printed Name of Signature Above*

First NameLast Name
Signature of Witness*

Clear
Date*

MonthDayYear
Date
Printed Name of Signature Above*

First NameLast Name
Should be Empty:

2024-2025 College Tour Application

Applicant Information

Essay – 150 words or less

Parent Information

Student medical history and authorization

Signatures