Youth Initiatives Application

Parent/Guardian Information
Primary Parent/Guardian's Name*

First NameLast Name
Primary Parent/Guardian's Email Address*
example@example.com
Primary Parent/Guardian's Cell Phone*
Please enter a valid phone number.Format: (000) 000-0000.
Primary Parent/Guardian's Secondary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
MotherFatherGuardianOther
YesNo

Acknowledgements and Authorization
Dear Parents/Guardians and Scholars: 

We appreciate your interest in the EP/CP Educational Development Youth Program initiatives. Our efforts are positively received within the community and we consistenly reach or exceed enrollment goals. Please carefully review the following declarations before signing and committing to your potential program enrollment.  

Student Applicant Declaration

By signing this form, I attest that I am willingly applying to be a participant in the EP/CP Youth Development Program. I also acknowledge that upon selection into the program, it is my responsibility to:
- attend all scheduled meetings and activities.
- actively engage in group discussions and interactions, and
- actively contribute to the learning environment by completeing required assignments and activities.
- I understand that unexcused absences or extended absence without notice could result in my dismissal from the program.
Scholar's Signature*

First NameLast Name
Delta Sigma Theta Sorority, Inc. requires all chapters to follow nationally prescribed risk management procedures for youth programs, which includes risk management training and an orientation. If you plan to participate field trips/college tour, you will be required to undergo a background screening.  September is reserved for the required training and orientation. Details on completing this portion of enrollment will be provided to accepted applicants. 
PARENT/GUARDIAN AUTHORIZATION:

I do hereby affirm to the East Point/College Park Alumnae Chapter of Delta Sigma Theta Sorority, Inc. that I authorize the participation of the minor child listed on this application in the designated EP/CP Youth Development Program Initiative (Academy, GEMS, or EMBODI). I have the legal authority as the parent/guardian to provide my consent and authorization for such participation. I also attest that I will support my child's participation by attending the parent orientation and ensuring my child has transportation to and from activities.
Primary Parent/Guardian's Signature*

First NameLast Name
Should be Empty:

Youth Initiatives Application

About the Scholar

Parent/Guardian Information

Acknowledgements and Authorization