BCAC DST 2026-2027 Youth Programs Application

Dear Parent/Guardian:

The Brevard County Alumnae Chapter of Delta Sigma Theta Sorority, Inc., is excited to invite your son and/or daughter to participate in one of our three dynamic youth initiatives during the 2026–2027 school year!

In support of Delta Sigma Theta's Educational Development Thrust, our mission is to empower young women and men of great promise in North and Central Brevard County who may be in need of additional support, resources, and encouragement. We take a holistic approach to accelerate their academic, social, and emotional growth, ensuring they are prepared to be confident, engaged leaders in their communities.

If there are any questions, please do not hesitate to email them to: info@dstbcac.org

Sincerely,
Kim Carter, President
Amanda Higgs, Programming Planning & Development Chair
Susan Jenkins, Chair - Educational Development

www.dstbcac.com

Follow us on Facebook: @BrevardDST

Youth Programs Overview

Delta Academy
(Middle School Girls 11-14 years old)

Delta Academy empowers young girls in grades 6–8 through structured activities that support their academic excellence, social-emotional and physical development, and leadership growth. The program fosters confidence, goal setting, and community engagement by providing tools for success, encouraging compassionate service, and inspiring girls to plan for high school and beyond

DELTA GEMS
(High School Girls 14-18 years old)

Delta GEMS (Growing & Empowering Myself Successfully) inspires at-risk African American girls ages 14–18 to excel academically, develop leadership skills, and prepare for college and careers. Through goal setting, service learning, and self-reflection, the program builds a “can do” attitude while empowering young women to become compassionate, confident, and community-minded leaders.

Youth Initiative Program of Interest (SELECT ONE)

Is the youth returning to the BCAC-DST Educational Development Youth Initiative Program?

Student Name

First NameLast Name

Date of Birth

Date

Select One:

Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Student Cell Phone Number

Format: (000) 000-0000.

Student Email

example@example.com

Participant's TShirt Size:

Name of Current School (Please give FULL name and not an abbreviation)

Grade Level for 2026 - 2027 School Year

Why do you want to be involved with the program? What do you hope to gain or learn by participating in this program?*

What subject(s) would you like to learn about or are you interested in?

Career Goals

Honors & Awards

Extra-Curricular Activities/Hobbies:

Do you have any dietary restrictions?

Is there anything that you consider special or unique about yourself that you would like to share? Please explain.

Parent/Guardian #1 Name

First NameLast Name

Parent/Guardian #1 Home Phone Number

Format: (000) 000-0000.

Parent/Guardian #1 Cell Phone Number

Format: (000) 000-0000.

Parent/Guardian #1 Email

example@example.com

Parent/Guardian #1 Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian #2 Name

First NameLast Name

Parent/Guardian #2 Phone Number

Format: (000) 000-0000.

Parent/Guardian #2 Cell Phone Number

Format: (000) 000-0000.

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

Relationship to student

Emergency Contact Best Contact Phone Number

Format: (000) 000-0000.

Emergency Contact Email

example@example.com

Emergency Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parents/Guardians: Please upload the required release forms in Appendix B1-B8 that were emailed to you. Forms can also be accessed via the link above.

I give permission for Brevard County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. to publish on the internet or media still photographs or moving images. I hereby hold harmless and release and forever discharge the Chapter , its officers, members, National Executive Board, representatives, etc. When a photograph of any youth is used online (or in materials that will be posted online), no identifying information will be included.

APPLICANT (YOUTH) Signature. This is a signature box, which will require you to press /hold your mouse with one hand and write your signature with the other.*

Date

PARENT/GUARDIAN OF YOUTH Signature This is a signature box, which will require you to press /hold your mouse with one hand and write your signature with the other.*

Date

2026 - 2027 Youth Programs Application

Application Deadline: October 15, 2026

YOUTH PARTICIPANT INFORMATION

SCHOOL INFORMATION

PROGRAM INTEREST

PARENT/GUARDIAN PERSONAL INFORMATION

Upload All Youth Program Addendum Forms

Statement of Applicant