Delta Sigma Theta Sorority, Inc.Contra CostaAlumnae Chapter

Delta Sigma Theta Sorority, Inc.Contra CostaAlumnae Chapter
CCAC Youth ProgramsAPPLICATION PACKET
PROGRAM YEAR 2026-2027
Please indicate the CCAC Youth Program for which you are applying by marking the appropriate box.
All applications should be received on or before October 4th, 2026.

Delta Sigma Theta Sorority, Inc.
Delta Sigma Theta Sorority, Inc. is a private, non-profit organization whose purpose is to provide assistance and support through established programs in local communities throughout the world. Twenty-two students at Howard University founded the sorority in 1913. These young women wanted to use their collective strength to promote academic excellence, provide scholarships, support the underserved, educate and stimulate the establishment of positive public policy, and to highlight issues and provide solutions for problems in their community. A sisterhood of more than 200,000 predominately Black college-educated women, the Sorority currently has over 900 chapters located in the United States, England, Japan, Germany, Bermuda, the Virgin Islands, the Bahamas and the Republic of Korea. The major programs of the sorority are based upon the organization's Five Point Programmatic Thrust:
- Δ Economic Development
- Δ Educational Development
- Δ International Awareness and Involvement
- Δ Physical and Mental Health
- Δ Political Awareness and Involvement
The Contra Costa Alumnae Chapter was chartered in 1990 to serve the residents of Contra Costa county. We take pride in the fact we are empowering the community and improving the quality of life for hundreds of families. The chapter provides an extensive array of public service programs and projects. Our programs are guided by the needs of our local community and by the Sorority's Five-Point Programmatic Thrust, described above.
The Dr. Betty Shabazz Delta Academy is a national initiative of Delta Sigma Theta Sorority, Inc. The Delta Academy is named for the outstanding and accomplished widow of Malcolm X, a registered nurse who ultimately earned a doctorate degree in higher education administration and curriculum development. The Delta Academy was created out of an urgent sense that bold action is needed to address the issues confronting our young females, such as academic failure and low self-esteem. The symbol for the Delta Academy is the Dream Catcher. A Dream Catcher, from Native American culture, is believed to possess the power to capture bad dreams, entangling them in the catcher's web, thus allowing only good dreams to pass through and into the person's being. The Delta Academy is a dream catcher! It helps its members recognize and plan for reaching their dreams. Through the program, the young ladies learn to make their dreams a part of their being and a foundation for their future.
The goals of the Delta Academy are achieved through challenging and fun activities, field trips, and other special incentives. Particular emphasis is placed on math, science, technology, self-esteem, non-traditional careers, community service, learning skills, and leadership development. The Delta Academy, specially designed for young ladies 11 – 14 years of age, will provide scholarship, service activities, and sisterhood enrichment opportunities for young ladies to prepare them for the 21st century and beyond. We are seeking young ladies who are interested in developing their leadership skills, in exploring career opportunities in computers and technology, and in being exposed to new ideas and experiences. All of this will take place in a fun and safe environment. The Delta Academy will discuss meeting frequency at the first informational. Meetings and activities will take place from September to June. For more information, contact the committee co-chairs at deltaacademyccac1@gmail.com

The Dr. Jeanne L. Noble Delta GEMS Institute honors the 12th National President of Delta Sigma Theta Sorority, Inc. Dr. Noble was a legendary pioneer in the field of education and social action. The Delta GEMS Institute focuses on teenage girls between the ages of 14 and 18. During Dr. Noble's tenure as National President, the sorority shaped its purpose and identity as a public service organization. Dr. Noble stressed the need for women to become increasingly less social and more social action oriented. Highly respected as a master teacher, lecturer, research scholar, writer and consultant, Dr. Noble held the distinction of being the first Black woman to move through a tenured track from assistant to full professor at a predominately white university, New York University. She was appointed by United States Presidents Lyndon Johnson, Richard Nixon and Gerald Ford to serve on various National Commissions.

The Delta GEMS Institute is a continuum of services that address the needs of young African American women in grades 9 through 12 with a framework for the participants to discover and understand their individual brilliance by embracing the GEMS theme: Growing and Empowering Myself Successfully.

The goals of the Delta GEMS are to instill the desire for academic excellence; to provide tools that enable girls to sharpen and enhance their academic skills; to assist girls in goal setting and planning for their futures in high school and beyond; to create compassionate, caring, and community minded young women; and to actively involve them in service advocacy and community service opportunities. The Delta GEMS will discuss meeting frequency at the first informational. Meetings and activities will take place from September to June. For more information, contact the committee co-chairs at gemsinstituteccac@gmail.com
Empowering Males to Build Opportunities for Developing Independence (EMBODI) is the signature program of Delta Sigma Theta Sorority, Inc.'s 24th National President, Cynthia M.A. Butler-McIntyre. EMBODI is designed to facilitate Delta's efforts to collaborate with other established organizations and agencies to address the plight of African American males. The EMBODI program provides a continuum of services that address the specific needs of African-American males.

Both informal and empirical data suggests that African American males continue to be in crisis educationally, socially, and emotionally. EMBODI is designed to address these issues through dialogue, field trips, and creative programs and activities.

The goals of EMBODI are to expand the horizons of young African American males by helping them cultivate a personal vision for their lives; to provide tools for young African American males to attain a higher quality of life; to provide young African American males with an awareness of various college and career options so that they can make rewarding life choices and decisions; and to create community-minded young African American males by actively involving them in service learning and community service opportunities.

This program serves as a motivational tool for African American teenage males ages 11 - 18 with the ultimate goal of increasing their knowledge and awareness of issues affecting young men today. EMBODI will discuss meeting frequency at the first informational. Meetings and activities will take place from September to June. For more information, contact the committee co-chairs at ccac1990embodi@gmail.com

DELTA SIGMA THETA SORORITY, INCORPORATEDCONTRA COSTA ALUMNAE CHAPTERDELTA ACADEMY, DELTA GEMS & EMBODI YOUTH PROGRAMS
STUDENT APPLICATION FORM
•• September 2026 – May 2027
Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Program:
Student Name:

First NameLast Name
Name of Parent/Guardian:

First NameLast Name
DOB:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Age:
Current Grade:
Student Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student Home Phone:
Format: (000) 000-0000.
Student Cell Phone:
Format: (000) 000-0000.
Student E-mail address:
example@example.com
School Name: (Please give FULL name)
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Favorite School Subjects:
Extra-Curricular Activities:
Hobbies:
Talents (What you do best and/or most like to do?):

Why would you like to participate in the CCAC Youth Program?
What new subject(s) would you like to learn about?
Shirt Size:
**Missing 2 or more consecutive meetings will jeopardize your participation in the CCAC Youth Program**
Student Signature and Date:
Student Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Effective Date: September 20th, 2026
Expiration Date: May 31, 2027
Page 5

DELTA SIGMA THETA SORORITY, INCORPORATEDCONTRA COSTA ALUMNAE CHAPTERDELTA ACADEMY, DELTA GEMS & EMBODI YOUTH PROGRAMS
PARENT CONSENT FORM
September 2026 – May 2027
Parent/Guardian Name:

First NameLast Name
Students Name:

First NameLast Name
Relationship:
Address Details

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home Phone:
Format: (000) 000-0000.
Work Phone:
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
E-Mail Address (home or work):
example@example.com
Emergency Contact Name and Number:
How did you learn about this CCAC Youth Program?
Please list any illnesses, allergies, medications or physical limitations that the CCAC Youth Program committee members should be aware of:
Are there any concerns (health, emotional, family dynamics) about your son/daughter that you would like to share?
By my signature below, I hereby verify that the above information is accurate. My signature grants permission for my child to participate in the CCAC Youth Program, including the field trips and activities thereof. In giving my permission

to participate, I understand that s/he will take part in scheduled meetings, field trips, workshops, cultural, educational and recreational programs. I agree to provide transportation for my child to all scheduled meetings and activities. I further agree to pick up my child at the appointed time after the conclusion of the activity, meeting or event. I also agree to facilitate and support my child's timely attendance and participation.

I agree not to hold the Delta Sigma Theta Sorority, Inc., Contra Costa Alumnae Chapter of Delta Sigma Theta Sorority, Inc., any of the CCAC Youth Programs, individually or collectively, or any of its members responsible and/or liable for any injuries or illnesses that my child may sustain before, during or after the sessions of any of the CCAC Youth Programs. I also agree not to hold the above named organization, or its members or appointees, individually or collectively, liable for the loss or destruction of my child's property.
For assessment purposes, we may ask you to submit a copy of the grade reports of your child during the academic year. Would this pose a problem?
If "Yes", please explain.
**Missing 2 or more meetings will jeopardize your child's participation in the CCAC Youth Program**
Parent/Guardian Signature and Date:
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
The Contra Costa Alumnae Chapter Risk Management forms must be completed before your child can participate in the CCAC Youth Programs.
Effective Date: September 20th, 2026
Expiration Date: May 31, 2027

DELTA SIGMA THETA SORORITY, INCORPORATEDCONTRA COSTA ALUMNAE CHAPTERDELTA ACADEMY, DELTA GEMS & EMBODI YOUTH PROGRAMSCONSENT TO PHOTOGRAPH
September 2026 – May 2027
I, _________________________, consent to, and give permission for my child,

First NameLast Name
_________________________, (Student Name)

First NameLast Name
Should be Empty:

Delta Sigma Theta Sorority, Inc.Contra CostaAlumnae Chapter

CCAC Youth ProgramsAPPLICATION PACKET

PROGRAM YEAR 2026-2027

Delta Sigma Theta Sorority, Inc.

DELTA SIGMA THETA SORORITY, INCORPORATEDCONTRA COSTA ALUMNAE CHAPTERDELTA ACADEMY, DELTA GEMS & EMBODI YOUTH PROGRAMS

STUDENT APPLICATION FORM

Student Signature and Date:

DELTA SIGMA THETA SORORITY, INCORPORATEDCONTRA COSTA ALUMNAE CHAPTERDELTA ACADEMY, DELTA GEMS & EMBODI YOUTH PROGRAMS

PARENT CONSENT FORM

Parent/Guardian Signature and Date:

DELTA SIGMA THETA SORORITY, INCORPORATEDCONTRA COSTA ALUMNAE CHAPTERDELTA ACADEMY, DELTA GEMS & EMBODI YOUTH PROGRAMSCONSENT TO PHOTOGRAPH

September 2026 – May 2027