Delta Academy and Delta GEMS Application

Delta Academy & Delta G.E.M.S. Application

2026-2027
Dear Applicant and Family,

Thank you for your interest in the Delta Academy and Delta G.E.M.S. programs sponsored by the Springfield Alumnae Chapter of Delta Sigma Theta Sorority, Inc. We are excited that you are considering becoming part of our youth development programs, which are designed to inspire leadership, academic excellence, sisterhood, and service.

Delta Academy serves middle school girls ages 11–14 and provides opportunities to build self-confidence, strengthen character, explore STEM, and develop leadership skills through engaging workshops and community service experiences.

Delta G.E.M.S. (Growing and Empowering Myself Successfully) is designed for high school girls ages 14–18. The program encourages participants to discover their strengths, set meaningful goals, prepare for college and careers, and grow as confident leaders while making a positive impact in their communities.

Both programs are part of the national youth initiatives of Delta Sigma Theta Sorority, Inc. and are guided by the Sorority's Five-Point Programmatic Thrust:
- Economic Development
- Educational Development
- International Awareness and Involvement
- Physical and Mental Health
- Political Awareness and Involvement
Your interest in applying reflects a commitment to personal growth, academic achievement, leadership, and community service. We look forward to learning more about you and the opportunity to support your journey throughout the 2026–2027 program year.

By submitting this application, my parent/guardian and I acknowledge that:
- I reside in the Greater Springfield area.
- I understand that the program meets monthly from September 2026 through May 2027, and I am committed to attending and actively participating in the scheduled sessions.
Application Deadline: Tuesday, September 1, 2026
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I am applying to the following program
Has the applicant previously participated in Delta Academy or Delta G.E.M.S.? If yes, please list the program(s) and year(s) of participation.
Participant's Information

This section should be completed by the parent/legal guardian
Participant's Name

First NameMiddle NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Age
Applicant's Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Which grade will the applicant be in for the upcoming 2026-2027 school year?
Applicant's Graduation Year
Which school or educational program will the applicant attend during the 2026–2027 school year?
Applicant's T-shirt size
Please list any allergies, medical conditions, or other health concerns we should be aware of to help ensure your child's safety and well-being during program activities.
Parent/Legal Guardian Information

This section should be completed by a parent/legal guardian
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to the Applicant
Is anyone in your family a member of Delta Sigma Theta Sorority, Inc.? If yes, please provide the member's name and relationship to the applicant. If no, please enter N/A.
Consent & Authorization Forms

This section should be completed by the applicant's parent/legal guardian
I, the undersigned, voluntarily give my permission for my daughter, the student named in this application, to participate in Delta G.E.M.S. or DeltaAcademy. I affirm that I am authorized to grant this permission and understand that her participation in the program is entirely voluntary.Delta G.E.M.S. and Delta Academy, sponsored by the Springfield AlumnaeChapter of Delta Sigma Theta Sorority,Inc., are committed to providing a supportive and enriching environment to promote the personal and academic development of all participants. While every effort will be made to ensure the safety and well-being of each student, the program committee members are not responsible for guaranteeing the physical, mental, social, or medical health of participants. As the parent/legal guardian, I acknowledge that I am ultimately responsible for the welfare of my child. I also understand that if my child’s behavior does not reflect the values and expectations of the Delta G.E.M.S. orDelta Academy programs, her participation may be suspended at the discretion of the committee.
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
I, as the parent or legal guardian of the applicant, voluntarily release, waive, discharge, and agree to hold harmless Delta Sigma Theta Sorority, Incorporated, its National Executive Board, officers, employees, members, local chapters, representatives, agents, affiliates, and assigns, from any and all claims, demands, or causes of action arising out of or relating to my child's participation in Delta Academy or Delta G.E.M.S. This release includes, but is not limited to, claims involving injury, illness, death, property damage, or loss arising from program participation, except where such injury or loss is the direct result of gross negligence or willful misconduct.I further understand and agree that Delta Sigma Theta Sorority, Incorporated, including its National Executive Board, local chapters, members, employees, volunteers, and representatives, is not responsible for the loss of or damage to my child's personal property.
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Authorization to Receive Text Message and/or Emails

This section should be completed by a parent/legal guardian
I authorize the Delta Academy or Delta G.E.M.S. program and the Springfield Alumnae Chapter of Delta Sigma Theta Sorority, Inc. to contact me via text message, email, and/or WhatsApp regarding program updates, meeting reminders, events, volunteer opportunities, emergencies, and other important information related to my child's participation.I agree to be added to the official Delta Academy or Delta G.E.M.S. WhatsApp group for program-related communications and understand that it will be used to share announcements, reminders, and other important program information. I understand that standard messaging and data rates may apply.By signing below, I acknowledge that I have read, understand, and agree to receive program-related communications through these methods.
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Emergency Contacts

This section should be completed by a parent/legal guardian
Name of Emergency Contact Person #1
Relationship of Emergency Contact Person #1
Telephone Number of Emergency Contact Person #1
Please enter a valid phone number.Format: (000) 000-0000.
Name of Emergency Contact Person #2
Relationship of Emergency Contact Person #2
Telephone Number of Emergency Contact Person #2
Please enter a valid phone number.Format: (000) 000-0000.
Personal Responses

This section should be completed by the applicant
How did you hear about the Delta Academy and Delta G.E.M.S. programs?
Why do you want to be a part of the Delta Academy or Delta G.E.M.S. program?
Tell us about yourself. In 1–2 paragraphs (150–300 words), introduce yourself. Share your interests, hobbies, strengths, school or community activities, future goals, and why you would like to participate in Delta Academy or Delta G.E.M.S. Tell us what you hope to gain from the program and how you will contribute as a participant.
Applicant Certification
I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge.
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Delta Academy & Delta G.E.M.S. Application

Participant's Information

Parent/Legal Guardian Information

Consent & Authorization Forms

Authorization to Receive Text Message and/or Emails

Emergency Contacts

Personal Responses

Applicant Certification