2026 - 2027 Delta GEMS Application

2026 - 2027 Delta GEMS Application
Thank you for your interest in the Delta GEMS youth enrichment program for young women sponsored by the Pontiac Alumnae Chapter of Delta Sigma Theta Sorority, Incorporated. Please complete this application in its entirety by September 11, 2026.
Participant Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Format: (000) 000-0000.
Birthday

MonthDayYear
What school will you be attending in the fall?
What grade will you be in this fall?
Parent / Guardian Information
Name

First NameLast Name
Relationship to Applicant
Phone Number
Format: (000) 000-0000.
Email
Parent / Guardian Information
Name

First NameLast Name
Relationship to Applicant
Phone Number
Format: (000) 000-0000.
Email
Additional Information
Who referred you to Delta GEMS?
What extracurricular activities are you involved in (school, community, church)?
Why do you want to participate in the Delta GEMS program? What does GEMS (Growing and Empowering Myself Successfully) mean to you? What do you think you will gain by participating in this program?
A letter of recommendation must be submitted with this application. The letter should be from someone who knows you well (teacher, school counselor, employer, advisor or any club or organization, mentor, etc.) Recommendation letters from relatives will not be accepted. Recommendation letters should include the following information:
- The capacity in which he/she has known you.
- Positive character traits about you.
- Your leadership skills/strengths.
- Reason(s) why your membership in Delta GEMS would enhance the program.
Attach your letter of recommendation below.

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Delta GEMS Shirt Size
Acknowlegement Statement
I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge. Prior to notification of acceptance into the GEMS program, interested participants must complete a virtual interview with program leadership on Sunday, September 20, 2026. If accepted into the GEMS program both the parent/guardian and the youth participant must attend the Parent Youth Orientation on Saturday, September 26, 2026 to continue with the program.
Parent / Guardian Signature
MonthDayYear
Date
Youth Signature
MonthDayYear
Should be Empty:

2026 - 2027 Delta GEMS Application

Participant Information

Parent / Guardian Information

Parent / Guardian Information

Additional Information

Acknowlegement Statement