• 2026-2027 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Greetings Delta GEMS applicants, 

    Delta GEMS Educational Program has a focus on enriching the lives of teen girls ages 14-18 in grades 9-12. GEMS is an acronym for Growing and Empowering Myself Successfully and that is the goal for the teens in this program. Delta GEMS provides the framework to actualize the dreams of these teen girls through the development of a positive and empowering attitude.

    The Delta GEMS logo is a gem. The gem symbolizes the hidden treasure in unpolished jewels. These jewels are the teen girls.

    The PWCAC Delta GEMS committee warmly welcomes your child to apply to participate as a 2026-27 Delta GEM. Below you will learn more about the program and you will be able to access the application. 

    Program Goals:

    • To develop strong, confident, and respectful teens to prepare them to take an active role in their success and society
    • To develop effective written and oral communication skills
    • To encourage the teens' self-confidence, self-motivation, and self-discipline
    • To foster meaningful public service activities, including mentoring and networking
    • To strive for intellectual enrichment and academic excellence
    • To assist in the exploration of career paths and educational skills
    • To support talents in academics, STEM, sports, and fine arts
    • To set goals, understand boundaries, and practice time management
    • Ultimately, the Delta GEMS program strives to ensure its participants’ experience increased self-esteem, heightened academic success, leadership skills, cultural awareness, and an expanded knowledge of what it means to serve the community - these benefits will assist and improve the teens as they transition to young adults.  

    Delta GEMS Program Structure & Participant Expectations

    Delta GEMS participants should expect to:

    • At least one parent or guardian of the participant must attend the PWCAC Delta GEMS orientation on September 19th, 2026 from 10 a.m. until 12 p.m.
    • To attend GEMS workshops are held monthly from 2 p.m. - 4 p.m. beginning October and held through May (September and March will be on Saturdays)
    • To complete monthly RSVP with explanation if they cannot attend
    • To attend at least six workshops for the year
    • Encouraged not to miss more than three consecutive, unexcused sessions

    We look forward to seeing each of you and your parent/guardian at Orientation on September 19th, 2026 from 10 a.m. to 12 p.m. at Saunders Middle School. Please see flyer for details.

    Please contact pwcacdstgems@gmail.com with any questions. 

    Thank you,

    Melonie Barrow

    Regina 'Gina' Carrell

    Co-Chairs, PWCAC Delta GEMS

  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Eligibility and Application Details: New and Returning Applicants:


    -Must be a female student entering the 9th, 10th, 11th, or 12th grade this upcoming fall, between the ages of 14-18 years old, and attend high school or live in Prince William County.


    -Must complete the online application in its entirety by the October 2, 2026 deadline, including submitting:

    • A headshot photograph (JPEG, PNG, or the like format)
    • If applicant is a driver, a copy of valid driver’s license and proof of insurance
    • A Risk Management packet (must be completed by parent or guardian)

    Important Details
    No applications or materials sent via email will be accepted. All sections of the application must be completed and submitted via the online form only.

    Application deadline for all new and returning applicants: October 2, 2026 by 11:59 p.m.
    **Late submissions will not be accepted.**

    Please feel free to contact us at Pwcacdstgems@gmail.com with any questions or for assistance.

  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • What grade(s) have you been a Delta Gem in the past? (Select all that apply)*
  • Have you participated in the Delta Academy program?*
  • Do you currently have a sibling participating in a Delta GEMS program?*
  • Do you currently have a family member who is a member of the Prince William County Alumnae Chapter of Delta Sigma Theta Sorority, Inc.?*
  • Have you participated in any activities sponsored by Delta Sigma Theta Sorority, Inc (e.g., Delta Academy, MLK Experience Celebration, etc.)?*
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Are you currently employed?*
  • Do you plan to work during the next school year?*
  • Please select each topic that is of interest to you:*
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • How will your child travel to and from Delta GEMS workshops and activities? Please note the following: 1. Participants must be signed in and out of each session by an approved parent or guardian. GEMS with valid drivers license and parental consent can sign themselves in and out. If you have a learners permit you must be signed in by a parent. 2. Prince William County Alumnae Chapter members are not authorized to provide transportation and are not responsible for the participant’s travel to or from meetings and activities - it is the parent or guardians responsibility.*
  • Are there any additional individuals (other than parents/guardians & emergency contacts listed in this form) who you approve to transport your child? If yes, please list (this may include a sibling, grandparent, family friend, etc.):*
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Emergency Contact Information
    If the parent/guardian of a GEMS participant cannot be reached, please contact the following person(s) whom I/we, the parent(s) of the minor listed on this application, hereby authorize as an emergency contact. Emergency contacts must be adults with a means of transportation.  

  • Format: (000) 000-0000.
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • The health of the student is primarily the responsibility of her parent(s) or guardian(s). The Prince William County Alumnae Chapter strongly recommends annual health examinations, dental check-ups, and immunizations against preventable diseases. Our policy on health and safety implies a responsibility to the participants for their protection. It also implies the right of the organization to be assured, as much as possible, that the participants are physically able to take part in youth group activities.

  • Format: (000) 000-0000.
  • Allergies (check all that apply and specify nature of any allergic reactions):*
  • Are the student's immunizations up to date? (If not, please explain below.)*
  • Date of last Tetanus vaccination:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Parent Authorization for Emergency Medical Treatment
     

  • In case of medical emergency, I understand that every effort will be made to contact the parent(s) or guardian(s) of the student. In the event I cannot be reached, I hereby give permission to the physician selected by authorized representative(s) of the Prince Wiliam County Alumnae Chapter to hospitalize, secure proper treatment for and to order injection, anesthesia or surgery for my child.

  • Today's Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Consent & Authorization Forms

  • 18 year old (or will be 18): GEMS Participant Sign In/Sign Out Consent I, as parent or legal guardian, do hereby release, waive, discharge, covenant not to sue and agree to hold harmless Delta Sigma Theta Sorority, Incorporated, its officers, National Executive Board, employees, members, local chapters, representatives, agents, affiliates, and assigns, from any and all claims, demands, and actions of any and every kind directly or indirectly arising out of, or relating in any respect my child’s participation in Delta GEMS. My waiver and release of all claims, demands, actions, and liability shall include without limitation, any injury, illness, death, property damage, or loss to my child, which may be caused by any act or failure to act by the Delta GEMS program, unless such injury, illness, death, property damage or loss is a direct result of willful misconduct. I understand that, without limitation of the foregoing, neither Delta Sigma Theta Sorority, Incorporated, nor the Delta GEMS program, shall be liable and each is hereby released from all claims that may arise from loss or damage to my child’s personal property.
  • Media Release I voluntarily give permission for my daughter (the student whose name is listed on this application), to be photographed and/or recorded. My signature gives consent to the use of her likeness in any publication, educational material, advertising, news media, and World Wide Web materials that the Delta GEMS/Prince William County Alumnae Chapter may utilize and produce. I understand and agree that such materials, including all negatives, positives, digital images, and prints shall become and remain the sole property of the Delta GEMS/Prince William County Alumnae Chapter and I shall have no right or title to such items. I further understand and agree that these materials may be kept on file and used by the Delta GEMS/Prince William County Alumnae Chapter for potential future use. I agree to release the Delta GEMS/Prince William County Alumnae Chapter from any and all liability arising from or in connection with the taking, use, publication, or dissemination of such materials. Copies of these photos may be distributed to the parent upon request.*
  • Do you consent to your child's image to be on PWCAC website and social media?*
  • Do you consent to your child's image to appear on images or video media associated with the PWCAC Delta GEMS/American Red Cross Blood Drive in honor of Candis King?*
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Authorization to Receive Delta GEMS Program Information via Email

  • I agree to receive Delta GEMS relevant program information via email.*
  • I give the participant (future GEM) permission to receive text messages, emails, Evites, and/or GroupMe messages related to program information and/or related program activities.*
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
  • Delta GEMS Code of Conduct Statement

    I will cooperate with all adults in charge. I will be sensitive to the needs of each participant.

    I will respect the people and places with which I come in contact.

    I will adhere to the Delta GEMS dress code.

    I will participate in required activities & discussions, be on time for all scheduled activities, and be open to new ideas. In the event I must miss an event, I will follow the absence reporting procedure. In the event of an unforeseen emergency, I will contact the GEMS Chair at least 24 hours ahead of the activity.

    I understand that obscene language and the use of alcohol, tobacco, and illegal or unauthorized drugs, and fighting will not be tolerated. Such usage during any activity may result in immediate dismissal from the program.

    I will remember that I am a member of a program sponsored by the Prince William County Alumnae Chapter of Delta Sigma Theta Sorority, Inc., and I must abide by a high standard of conduct. My behavior will reflect the high values and expectations for conduct and ladylike etiquette described in this Code of Conduct.

    I will not make negative remarks on social media about program participants nor the Southfield Alumnae Chapter of Delta Sigma Theta Sorority, Inc.

    I will not leave any GEMS event without signing out or acknowledging early departure with the program chairs.

    I will be responsible for all of my personal belongings.

    I understand that I will receive two warnings for unacceptable behavior. After two warnings, my parent/guardian will be notified. I understand if I am sent home early due to any misconduct, it will be my parent’s responsibility to provide transportation. I also understand that any additional costs for transportation will be my parent’s responsibility.

    I understand that more than three unexcused absences may result in my being dropped from the program and may prohibit me from being able to participate in any program activities.

    I understand that my attitude and behavior are central to the success of the Delta GEMS program.

    Therefore, for the good of this program, as well as for myself and my fellow group members, I agree to abide by the statements above. I understand that there are sanctions for violations which may include removal from the program.

     

     

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • As the parent/guardian, I understand and agree with the above responsibilities fully accepted by my daughter. I will not hold Southfield Alumnae Chapter or its members responsible if my daughter is sent home early and/or discharged from the program due to misconduct.

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 2026-27 Delta GEMS Application

    Prince William County Alumnae Chapter | Delta Sigma Theta Sorority, Incorporated
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  • Click here to download the fillable Risk Management parent packet.

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