25-26 BXAC Delta GEMS Youth Initiative Program Application Form

Delta GEMS Growing & Empowering Myself Successfully Helping GEMS “Discover their individual Brilliance.”

Bronx Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated
Youth Initiative Application 2025 - 2026
Dear Parent/Guardian:

Thank you for your interest in our Chapter's award-winning FREE Mentorship Program Delta GEMS "Growing and Empowering Myself Successfully." Delta GEMS is a mentoring program for young ladies ages 14-18 to guide participants in creating a college and career planning roadmap. Delta GEMS was established as a logical progression and extension of the immensely popular Dr. Betty Shabazz Delta Academy: Catching the Dreams of Tomorrow.

Delta GEMS offers the framework to make those dreams a reality by completing specified tasks that foster a CAN DO attitude. Delta GEMS's objectives are To instill the necessity of academic excellence, To give young ladies the resources they need to hone and improve their abilities to succeed academically at a high level, To help young ladies create realistic goals and make plans for their high school and post-high school futures; and to actively involve young women in service-learning and community service to develop compassionate, caring, and community-minded individuals.

Delta GEMS program produces activities that encourage introspection and personal development and provides a roadmap for college and career planning. The Delta GEMS program offers a road map for college and career planning through activities that provide opportunities for self-reflection and individual growth. Chapters of Delta Sigma Theta Sorority, Incorporated implement delta GEMS. Delta GEMS participants have the chance to define and "Discover their Brilliance." The Delta GEMS Youth Initiative is designed for:

▲Young women ages 14-18 who are in Grades 9 through 12.

▲ Young women with potential need guidance, support, and skills to succeed.

▲ Young women who are interested in developing leadership skills.

▲ Young women who are actively pursuing college and/or career options.

▲ Young women who need encouragement and support in pursuit of higher learning.

▲ Young women identified by authorized partners of Delta chapters and/or former Delta Academy participants.

Applications are due by First Friday Monthly at 11:59 pm, we are excited to work with your youth.

If you have any questions, please do not hesitate to email them to Deltagems@dstbxorg.

Sincerely,

Azareal McCarthy, Chair - Delta GEMS
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Student Name*

First NameLast Name
Age*
9th 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)*
School City*
School County*
T-shirt Size (Best efforts will be made to provide the size selected. Some vendors do not offer certain sizes).*
Extra-Curricular Activities:*
What is your favorite Snack or Food?*
Do you have any dietary restrictions?*
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 If different from above

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 Best Contact Number*

Area CodePhone Number
Emergency Contact Email
example@example.com
Relationship*
Please download a copy of the Application and Consent form linked and highlighted below.

Parental/Guardian Application & Consent Form
Please upload a completed copy of the Parental/Guardian Application & Consent form which can be found linked above. If for any reason you cannot access the link, please e-mail Risk@dstbx.org and ask for the application.*

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Delta GEMS Growing & Empowering Myself Successfully Helping GEMS “Discover their individual Brilliance.”

Youth Initiative Application 2025 - 2026