Delta G.E.M.S. Application

Delta GEMS 2024 - 2025 Application

St. Louis Alumnae Chapter of Delta Sigma Theta Sorority, Inc.
GEMS is an acronym for Growing and Empowering Myself Successfully and designed to provide a vehicle of change for young African-American women between the ages of 14 and 18 to enhance their abilities and increase their self-worth, in order to achieve academic and Black girl excellence.
Youth Information
Youth Name*

First NameLast Name
Birth Date*

MonthDayYear
School Name*
Grade*
Youth Cell Number*

Area CodePhone Number
Youth E-mail*
example@example.com
Youth Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Information
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Home Number

Area CodePhone Number
Parent/Guardian Cell Number*

Area CodePhone Number
Parent/Guardian E-mail*
Parent/Guardian 2 Information
Parent/Guardian Name 2

First NameLast Name
Parent/Guardian Home Number 2

Area CodePhone Number
Parent/Guardian Cell Number 2

Area CodePhone Number
Parent/Guardian E-mail 2
example@example.com
Are you a Delta Academy graduate?

YesNo
Are you a returning GEM?

YesNo
Is there anything you’d like the curriculum to address this year?
Youth Code of Conduct

(Student and Parent Read Together)
1.Respect all participants (other youth and adult volunteers) by not using foul, hurtful or obscene language or engaging in physical violence, bullying (including cyber-bullying) or other aggressive behaviors that threaten the safety of others.
2. Respect the property rights of others. This means do not damage or deface the building or property within the building where chapter activities are held; do not damage or take the personal property of any other participant or volunteer; and do not use Delta’s name or any symbol or logo (Delta’s intellectual property) on any clothing, books, bags, or other items.
3. Return supplies to their proper place after using them.
4. Clean up all work areas properly.
5. Listen carefully to directions and when someone else is talking.
6. Respect designated quiet areas, such as homework/reading area.
7. Stay within the program’s designated areas within the building.
8. Cooperate and participate in organized activities.
9. Assume full responsibility for all personal belongings. Please leave valuables at home.
10. Do not bring any weapons, cigarettes/drugs, alcohol, or anything illegal to any activity at any time.
Code of Conduct Sanctions

Bad Language/Abusive Teasing and Related Acts:
1st Time: Verbal warning, parent or guardian notified from this point forward.
2nd Time: Loss of privileges.
3rd Time: 1-week suspension from program.
Next occurrence youth is removed from the program.

Physical Violence and Other Misconduct:
1st Time: Removal from situation, loss of privileges, guardian notified from this point forward.
Next occurrence youth is removed from the program.

Illegal Substances or Dangerous Weapons
1st Time: Youth is removed from the program. If a youth is in possession of an illegal substance or dangerous weapon, the police will be notified as well.
Student: With my parent or other adult, I have read the Code of Conduct and sanctions for violating the Code. I understand the Code and the sanctions. I will follow the Code of Conduct. Please Sign and date.*

Clear
Date*

MonthDayYear
Date
Parent: I have read and understand the Code of Conduct and sanctions for violating the Code of Conduct. I understand that my child’s compliance with the Code of Conduct is a condition of her/his participation in the program. I agree that the sanctions for violating the Code of Conduct are reasonable and will help my child comply.
Parent's Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Delta GEMS 2024 - 2025 Application

Youth Code of Conduct