RISK MANAGEMENT YOUTH INITIATIVE VOLUNTEER FORMS PACKAGE

The forms contained herein have been approved by Delta Sigma Theta Sorority, Incorporated, for use by all Chapters. To minimize risk and legal liability, Chapters are prohibited from modifying or altering these forms, except for inserting the name of the Chapter, Youth, Parent/Guardian, or Volunteer.

Delta Sigma Theta Sorority, Incorporated 1707 New Hampshire Avenue, NW Washington, DC 20009

Contents

• A2:   YOUTH INITIATIVE VOLUNTEER APPLICATION
• A7:   SOME SIGNS AND SYMPTOMS OF CHILD ABUSE
• A8:   DELTA YOUTH INITIATIVES CODE OF ETHICS
• A11:  ANNUAL CONFIRMATION OF YOUTH VOLUNTEER STATUS AND INFORMATION UPDATE

 

The forms contained herein have been approved by Delta Sigma Theta Sorority, Incorporated, for use by all Chapters. To minimize risk and legal liability, Chapters are prohibited from modifying or altering these forms, except for inserting the name of the Chapter, youth, parent/guardian, or volunteer.

Delta Sigma Theta Sorority, Incorporated
Risk Management Manual Forms

APPENDIX A2

YOUTH INITIATIVE BOLUNTEER APPLICATIONS

It is the policy of Delta Sigma Theta Sorority, Incorporated (“Delta”) that each potential volunteer for any of its youth initiatives programs be screened by the Chapter. As part of the screening process, you are required to:

1. Complete this written application.
2. Consent to background screening, which includes: (1) state and/or federal criminal background
   checks and (2) search of state and federal sex offender registries.
3. Provide two personal references and two professional references.
4. Copy of driver’s license or state issued identification.
5. Complete a personal interview.
6. Notify the Chapter immediately if convicted of an offense at any time after submitting this
   application.

In order to ensure that our youth initiative programs are conducted in a safe environment, all volunteers and parents or guardians who have direct contact with youth on multiple occasions must complete Delta’s FULL volunteer screening process, including an online criminal background check. The background check must be conducted by a vendor selected by Delta and the volunteer/parent or guardian is responsible for payment of the background fee. The criminal background check fees average between $35 ‐ $130 and are non‐refundable. The chapter will provide the necessary information to access the online vendor selected by Delta.

I, {name} hereby authorize the local Chapter of Delta Sigma Theta Sorority, Incorporated (the “Chapter”) to conduct background screening related to my application for a volunteer position with the Chapter’s youth initiative programs. The Chapter’s background screening procedures include the review of local, state, and nationwide criminal background checks, the search of state and federal sex offender and child abuse registries and other databases, and communication with personal and professional references.

I authorize the Chapter to obtain information necessary to complete its background screening procedures to be obtained from any relevant source, including federal, state, and local law enforcement agencies; searchable online official registries and databases; and individuals I have identified as personal and professional references.

I also authorize the Chapter to complete background screening on me on a triennial basis (every 3 years) for as long as I remain a volunteer if I am accepted as a volunteer and serve for more than one year. I further agree to complete all requirements to facilitate the Chapter’s completion of such background screening.

I also agree that once accepted as a volunteer, I must notify the Chapter immediately if I am the subject of any pending charges and/or convicted of an offense at any time after submitting this application or being cleared as a volunteer.

I also further acknowledge that a volunteer with pending charges relating to abuse, neglect, a drug related offense, any crime with the involvement of youth, termination from a paid or volunteer position related to misconduct with a youth, any crime involving violence or recent history of substance abuse, will be terminated as a volunteer.

I certify under penalty of perjury that the foregoing is true and correct.

Please list the names, addresses, and phone numbers of four people you would like to use as character references (only people you have known for at least one year). Any information Delta Sigma Theta Sorority, Incorporated gathers from these references will be treated confidentially and will not be released to you, the applicant.

APPENDIX A7

Although the definition of child abuse is broad, the following is offered as a guide. Child abuse consists of any act of commission or omission that endangers or impairs a child’s physical or emotional health and development. Child abuse includes any damage done to a child which cannot be reasonably explained, and which is often represented by an injury or series of injuries appearing to be nonaccidental in nature.

• Physical abuse, including neglect or lack of adequate supervision
• Emotional abuse or deprivation
• Sexual abuse 

Child abusers are found among all socio‐economic, religious, and ethnic groups and are most often ordinary people who are not strangers to the child or the child’s family.

A child abuser is usually a person closely related to the child such as a parent, step‐parent, or other caretaker, or someone whom the child trusts, such as a family friend, a minister or religious leader, social worker, coach, or counselor.

It is important to remember that child abuse is not usually a single act, but a repeated pattern of behavior. This is true of all types of abuse, physical, emotional, and sexual. The following symptoms are offered as general guidelines to help you identify an abused child.

• Bruises or welts appearing on the body, especially those which reveal the shape of some object used to produce them, e.g., sticks, belts, buckles, electrical cords, a hairbrush, etc.
• Bruises which are unexplained or located on parts of the body which usually do not get bruised in the bumps and falls that occur in a child’s everyday living. It is normal for a child to get bruises on his shins, knees, elbows, or forehead occasionally. It is suspect for a child to be bruised on the eyes, mouth, back, buttocks, genital areas, thighs, or calves
• Small circular burns appearing on face, arms, hands, buttocks, or soles of feet that may have been inflicted by a cigar or cigarette. 
• Burns with a “sock” or “glove‐like” appearance on hands or feet and “doughnut” shaped burns on the buttocks. These types of burns are usually caused by either dipping or forcing the child to sit in scalding liquid. 
• Burns that leave a pattern outlining the object which was used to make the burn such as an iron, electric burner, heater, or fireplace tool. 
• Burns caused by rope friction, usually found on legs, arms, neck or torso as the result of having been tied up. 
• Unexplained fractures to nose, face, ribs, legs, or other parts of the body. 
• Injuries in various stages of healing which appear in a regular pattern or are grouped together. 
• Other types of abrasions or lacerations appearing on the body, which have no apparent reasonable explanation. 
• Human bite marks, especially those that are adult sized.

• Child continually hungry. 
• Consistent lack of cleanliness or an intense obsession with cleanliness. 
• Clothing not suitable to weather conditions. 
• Evidence that the child’s physical and medical needs are not being met. 
• Lack of supervision especially in dangerous situations or while participating in
  activities which extend over long periods of times. 
• Behavior that does not appear “normal,” e.g., severe anxiety around other children or adults, anti‐social behavior in the form of hostile aggression, or withdrawn behavior accompanied by depression.

The negative effects of emotional abuse can be just as devastating to a child’s development emotionally, intellectually, and behaviorally as are the injuries sustained by physical abuse. Most physical abuse is accompanied by emotional abuse as well. Although this type of abuse is often more difficult to recognize and identify, an adult who is observant and pays close attention to a child will soon develop the ability to recognize troubling signs.

• Behavior which indicates apathy or depression.
• Behavior which is anti-social and hostile in nature.
• Loss of appetite, refusal to eat, and/or overeating as a source of comfort or substitute for being loved.

Sexual exploitation, molestation, and incest are additional devastating types of child abuse. The societal taboos surrounding this type of abuse make some communities reluctant to acknowledge the existence of this form of abuse, and this in turn, makes it more difficult for children to report it.

The nature of sexual abuse makes it difficult to observe and therefore often more difficult to report. The guidelines given here for the detection of sexual abuse are by no means comprehensive. Symptoms given here may exist singly or in various combinations. It is essential to remember that this form of abuse makes the child a victim. Those children who seek help are often accused of lying, as adults usually do not want to believe them. In addition, the victim of sexual abuse is most often pressured into secrecy about the sexual activity by the abuser, leaving the child feeling helpless and guilty because of her behavior with no place to turn for help and no acceptable way out.

• Child expresses or implies involvement in sexual activity with parent, another adult, or older child. 
• Child’s clothing appears stained, torn, or bloody. 
• Child reports pain, itching, bruises, or bleeding in the genital area. 
• Child has been diagnosed as having venereal disease of eyes, mouth, genitalia and/or anus. 
• An unwanted pregnancy occurs, and the victim is hesitant to reveal partner. 
• Child expresses the presence of severe emotional conflict at home but is fearful of intervention. 
• Child demonstrates withdrawn behavior, refuses to participate or dress appropriately for physical activities, and/or appears to spend extended periods of time in a fantasy world. 
• A young child demonstrates an exaggerated knowledge of or interest in adult sexual behavior evidenced by either seductive actions and conversations or shows fear of intimate contact with others. 
• A child is known to be the victim of other forms of abuse by parent(s).

It is important to remember when children report information related to sexual topics or suspicious activities, they need to be believed. It may be a cry for help.

APPENDIX A8

DELTA YOUTH INITATIVES CODE OF EITHICS

All members and any Delta staff working with participants in Delta’s youth initiatives are expected to observe a code of ethics. This Code of Ethics embodies the affirmation of your commitment to follow tenets that are integral to Delta’s youth initiatives. Please initial each statement below:

It is the policy of Delta Sigma Theta Sorority, Incorporated (“Delta”) that all staff, members, and any participant in the youth initiatives must immediately report any suspected child abuse and/or neglect of program participants or other incidents involving program participants. All such suspected reports must be made to appropriate state and/or local authorities, and to the Chapter President. The Chapter President shall notify the Regional Director immediately of all allegations of abuse and or neglect or other incidents involving program participants. Delta staff and all volunteers must follow their state’s mandatory reporting of child abuse and neglect procedures.

To report child abuse or neglect, contact Child Help USA at 1‐800‐422‐4453. For the most current information on State Child Abuse And Neglect Reporting Numbers and a list of reporting agencies and phone numbers organized by state, refer to the National Organizations section of Child Welfare Information Gateway at https://www.childwelfare.gov/organizations/.

The Delta Program appreciates your interest in becoming a volunteer. Please initial your understanding and agreement with each of the following:

• Copy of valid driver’s license
• Signed Youth Initiative Volunteer Application, which includes an Information Release and References

I understand that my signature below authorizes submission of the information in this application for child abuse and neglect and criminal records checks, including sexual offenses, if deemed necessary. In addition, by signing, I certify that all information provided herein is correct, and I agree with and will adhere to Delta’s Code of Ethics and Mandatory Reporting Policy as printed above.

Please read this carefully before signing:

Printed Name  *  {name}