Princess Anne Alumnae Chapter - Delta GEMS Program Application 2025-2026

Delta G.E.M.S. Application 2025-2026

Delta Sigma Theta Sorority, Inc. Princess Anne Alumnae Chapter

Annette Noble, Chapter President

Dear High School Student & Parent,

Thank you for your interest in the Princess Anne Alumnae Chapter's Delta G.E.M.S. Program!

The goals of Delta G.E.M.S. are to: instill the need to excel academically; to provide tools that enable girls to sharpen and enhance their skills to achieve high levels of academic success; to assist girls in effective goal setting and planning for their futures in high school and beyond; and to create compassionate, caring, community-minded young women by actively involving them in service learning and community service opportunities.

Who have potential, but need guidance, support and skills to achieve success

Who are interested in developing leadership skills

Who are actively pursuing college and/or career options

Who need encouragement and support in pursuit of higher learning

The Delta G.E.M.S. activities include participation in community service projects, cultural events, and attending educational workshops. The workshops will address topics such as choosing the perfect college, career choices, social and professional etiquette, self-esteem building, wellness, and money management.

Participation in this program requires commitment and dedication in order to make the program successful. It is important to note that transportation to and from meetings/local events are the responsibility of the parent/guardian.

Please submit your completed application by Friday, September 12, 2025

paacgems@gmail.com

Best Regards,

Dr. Kimberly Purvis, Chair

Full Name*

Address: (including city, state & zip)*

Student Telephone #*

Student Email Address*

example@example.com

Age*

School*

Grade*

Parent/Guardian #1 Name/Relationship*

Parent/Guardian Best Contact Number*

Parent/Guardian Email Address*

example@example.com

Parent/Guardian #2 Name/Relationship

Parent/Guardian Contact Number

Parent/Guardian EMail Address

example@example.com

How did you find out about the Delta G.E.M.S.?

1. Why do you want to participate in the Delta G.E.M.S. program?*

Career Aspirations*

2. What do you hope to get out of this program?*

List all extracurricular activities (please include work, community activities, public service projects and interests).*

Tee Shirt Size*

As a member of the Delta G.E.M.S., I (insert participant name)*

Please take a moment to carefully read the following important documents: the Delta G.E.M.S. Academy Statement of Commitment/Intent, the Youth Code of Conduct, and the Photograph, Media, and Video Authorization Release Form. These documents outline the expectations, responsibilities, and permissions required for participation in the Delta G.E.M.S. program. Your understanding and acknowledgment of each section are essential to ensure a positive and respectful experience for all involved.

Delta G.E.M.S. ACADEMY STATEMENT OF COMMITMENT/INTENT

1. I will participate in all Delta G.E.M.S. activities/functions. In the event that I cannot attend a Delta G.E.M.S. activity/function, I will notify my Delta G.E.M.S. Advisor at least three days prior to an activity.

2. I understand that my presence is required monthly, for activities (unless otherwise noted)

3. I will sign in at all Delta G.E.M.S. activities/functions.

4. I will interact and cooperate with all of my fellow Delta G.E.M.S. peers and advisors.

5. I will present good behavior and a positive attitude at all times.

6. I will have a willingness to serve my community.

7. I will share my viewpoints in a positive manner and respect those of others.

8. I will respect others at all times (i.e. no talking while others are speaking, cell phones OFF during activities/functions)

9. I will be an active listener.

10. I will not eat or chew gum at inappropriate times.

11. I will come prepared to participate in all activities/functions.

12. I will present myself in an appropriate manner.

13. I will adhere to the guidelines and instruction set forth by my Delta G.E.M.S. Advisors and Mentors.

14. I will establish and maintain a healthy relationship with Delta G.E.M.S. Advisors and fellow members.

YOUTH CODE OF CONDUCT

1.Respect all participants (other youth and adult volunteers) by not using foul, hurtful or obscene language or engaging in physical violence, bullying (including cyber-bullying)7 or other aggressive behaviors that threaten the safety of others.

2.Respect the property rights of others. This means do not damage or deface the building or property within the building where chapter activities are held; do not damage or take the personal property of any other participant or volunteer; and do not use Delta’s name or any symbol orlogo (Delta’s intellectual property) on any clothing, books, bags, or other items.

3.Return supplies to their proper place after using them.

4.Clean up all work areas properly.

5.Listen carefully to directions and when someone else is talking.

6.Respect designated quiet areas, such as homework/reading area.

7.Stay within the program’s designated areas within the building.

8.Cooperate and participate in organized activities.

9.Assume full responsibility for all personal belongings. Please leave valuables at home.

10.Do not bring any weapons, cigarettes/drugs, alcohol, or anything illegal to any activity at anytime.

Sanctions for Violating Code of Conduct

Bad Language/Abusive Teasing and Related Acts:

1st Time: Verbal warning, parent or guardian notified from this point forward

2nd Time: Loss of privileges

3rd Time: 1-week suspension from program

Next occurrence youth is removed from the program.

Physical Violence and Other Misconduct:

1st Time: Removal from situation, loss of privileges, guardian notified from this point forward

Next occurrence youth is removed from the program.

Illegal Substances or Dangerous Weapons

1set Time: Youth is removed from the program. If a youth is in possession of an illegal substance or dangerous weapon, the police will be notified as well.

PHOTOGRAPH, MEDIA, AND VIDEO AUTHORIZATION RELEASE FORM

I/We,"Parent/Guardian"), as parent(s) or legal guardian(s) of_ give permission for Princess Anne Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated (the "Chapter") to publish on the Internet or media still photographs or moving images, including, if applicable any sound recordings accompanying the images ("Images") taken of my child during participation in Delta G.E.M.S. Youth Initiative Program activities, without payment or any consideration and without notifying me in advance. I/We also give permission for the Chapter to highlight my child's achievements and activities in efforts to promote the youth initiative program through newspapers, radio, TV, the web, DVDs, displays, brochures, and other types of media without payment or any consideration and without notifying me. I/We understand and agree that these Images will become the property of the Chapter, which shall have complete ownership of the Images. I hereby irrevocably authorized the Chapter to publish or distribute these Images for the purpose of publicizing the Chapter's programs, including the Delta G.E.M.S. Youth Initiative Program or for any other lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my child's likeness appears. Additionally, I waive any rights to royalties or other compensation arising out of or related to the use of the Images. I/We hereby hold harmless and release and forever discharge the Chapter and any of its officers and members; Delta Sigma Theta Sorority, Incorporated; its officers; National Executive Board; employees; members; representatives; agents; and assigns from any and all claims, costs, suits, actions, judgments, and expenses which my child, his/her heirs, representatives, executors, administrators, or any other persons acting on his/her behalf have or may have by reason of the use of the Images. This release specifically includes, without limitation, a complete release and discharge of any liability by virtue of any editing, distortion, alteration, or optical illusion, whether intentional or otherwise, that may occur or be produced in the taking of or editing of said Images, unless it can be shown that such was maliciously caused, produced and published solely for the purpose of subjecting my child to conspicuous ridicule, scandal, reproach, scorn and indignity.

I/we hereby certify that I/we are the parents/guardians of the student and authorized legally to give this consent, and do hereby give my/our consent without reservation to the foregoing on behalf of my/our child.

Parent/Guardian Signature

Parent/Guardian Print Name

Participant Signature

Date

Participant Print Name

Parent/Guardian Acknowledgment

I have fully read and understand the (all) areas

Delta G.E.M.S. ACADEMY STATEMENT OF COMMITMENT/INTENT
YOUTH CODE OF CONDUCT
PHOTOGRAPH, MEDIA, AND VIDEO AUTHORIZATION RELEASE FORM
I also understand that my child's compliance with the Code of Conduct is a condition of her/his participation in the program. I hereby acknowledge, understand, and agree to comply with the terms set forth in the Participation Agreement.

Parent/Guardian Signature*

Date*

Date

Parent/Guardian Print Name*

Please submit your completed application by Friday, September 12, 2025 paacgems@gmail.com