RHPVACDST EMBODI Application 2025

E.M.B.O.D.I.

2025 Program Application
The women of the Rolling Hills / Palos Verdes Alumnae Chapter of Delta Sigma Theta Sorority, Inc. welcome young men ages 13-18 who are interested in joining EMBODI.

The EMBODI (Empowering Males to Build Opportunities for Developing Independence) program is designed to refocus the efforts of Delta Sigma Theta Sorority, Incorporated, with the support and action of other major organizations, on the plight of African-American males. Both informal and empirical data suggests that the vast majority of African-American males continue to be in crisis and are not reaching their fullest potential educationally, socially and emotionally. EMBODI is designed to address these issues through dialogue and recommendations for change and action. EMBODI addresses issues related to STEM education, culture, self-efficacy, leadership, physical and mental health, healthy lifestyle choices, character, ethics, relationships, college readiness, fiscal management, civic engagement and service learning.

Why Join EMBODI?

• Gain valuable skills in leadership, financial literacy, and academic excellence.
• Engage in thought-provoking discussions and activities on crucial topics like self-efficacy, healthy lifestyle choices, and civic engagement.
• Be part of a supportive community that fosters personal growth and positive relationships.
Application for Participation

Fall applications are open for additional participants. Applications are due on Friday, October 17th, by 11:59pm.

Program Orientation will be held Fall 2025. An email to notify parents of their child’s acceptance will be sent out prior to orientation.

Participants will meet monthly on Saturdays. A schedule of meeting dates will be available at the orientation meeting or via email.

If you have any questions, please email: rhpvacdst.embodi@gmail.com.
Select Applicant Type:
Applicant Name (Student)

First NameMiddle NameLast Name
Birthdate

MonthDayYear
Age (as of today)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
School Name
Current Grade (as of August 2025)
List your community and volunteer activities.
What extracurricular activities are you involved in? (i.e., sports, clubs, church ministries, etc).
List any outside jobs you have held while in high school, if any. Indicate N/A if not applicable.
How do you think being a participant of EMBODI would benefit you?
Student Name

First NameLast Name
Student Signature
Student Signature Date

MonthDayYear

2025 Parental Consent Form

RHPVACDST EMBODI
Parent/Guardian Name:

First NameLast Name
Relationship to Applicant
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact Name

First NameLast Name
Relationship to Applicant
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
By signing below, I hereby verify that the above information is true and accurate. The undersigned grants permission for the applicant to participate in monthly virtual meetings and activities therein and will facilitate the child’s timely attendance and participation.

I agree not to hold the Rolling Hills / Palos Verdes Alumnae Chapter of Delta Sigma Theta Sorority, Inc. or the EMBODI and its members responsible and liable for an injuries or illnesses that my child may sustain while in attendance at the sessions of the program. I also agree not to hold the above-named organizations, its members or appointees individual liable for the loss or destruction of my child’s property.
Parent/Guardian Name:

First NameLast Name
Consent to Participate - Parent/Guardian Signature
Signature Date

MonthDayYear

2025 Consent to Photograph

RHPVACDST EMBODI
Please Read Carefully and Sign Below

I, {parentguardian} give permission for my son, {applicantName} to be photographed and/or videotaped throughout the EMBODI program sponsored by the Rolling Hills / Palos Verdes chapter of Delta Sigma Theta Sorority, Incorporated.

Virtual meetings: I understand that if and when meetings are held virtually, they will take place on the Zoom web-conferencing platform. My child is expected to keep their camera on and have a working microphone to fully engage and participate in virtual activities.

In-person meetings: If there are in-person meetings, I understand that pictures may be taken to capture memories of our programs activities and shared on our social media platforms, such as Instagram and Facebook.

By signing below, I consent to the use of her likeness in any publication, educational material, advertising, news media, and World Wide Web materials that the EMBODI may utilize and produce.

I understand and agree that such materials, including all digital images, and prints shall become and remain the sole property of EMBODI and I shall have no right or title to such items. I further understand and agree that these materials may be kept on file and used for potential future use. I agree to release EMBODI from any and all liability arising from or in connection with the taking, use of publication, or dissemination of such materials.
Parent/Guardian Name:

First NameLast Name
Consent to Photograph - Parent/Guardian Signature
Signature Date

MonthDayYear

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. A sisterhood of more than 200,000 predominantly Black college educated women, the Sorority currently has over 900 chapters located in the United States, England, Japan (Tokyo and Okinawa), Germany, Hawaii, the Virgin Islands, Bermuda, the Bahamas and the Republic of Korea. The major programs of the sorority are based upon the organization’s Five Point Programmatic Thrust: Economic Development, Educational Development, International Awareness and Involvement, Physical and Mental Health, and Political Awareness and Involvement.

For more information about Delta Sigma Theta Sorority, Inc. visit: www.deltasigmatheta.org

The Sorority was founded in 1913 by 22 students at Howard University. These young women wanted to use their collective strength to promote academic excellence; to provide scholarships; to provide support to the underserved; educate and stimulate participation in the establishment of positive public policy; and to highlight issues and provide solutions for problems in their communities. The Rolling Hills/Palos Verdes Alumnae Chapter continues this legacy of service to the community.

Chartered on January 14, 2001, the Rolling Hills/Palos Verdes Alumnae chapter became the 941st chapter of the Sorority and is comprised of residents of the Palos Verdes Peninsula and surrounding South Bay communities. In serving the communities of Torrance, Lomita, Redondo Beach, Manhattan Beach, Hermosa Beach, Lawndale, Gardena, Hawthorne, Rancho Palos Verdes, Wilmington (Los Angeles), El Segundo, Harbor City and San Pedro the Rolling Hills/Palos Verdes Alumnae chapter of Delta Sigma Theta Sorority, Inc. continues to “Transform Lives and Impact Communities.” Since the chartering of the Rolling Hills /Palos Verdes Alumnae Chapter, over $100,000 in college scholarships have been awarded to more than three dozen young women and men in the South Bay communities of Los Angeles. Our Torchbearer’s Foundation has been able to support various organizations including the Harbor UCLA Black Infant Health Project, 731 Family Crisis Center, Torrance Care Center, Harbor Interfaith Services, Jenesse Center, Inc., Harbor Village Housing Project Obesity Action Coalition, Abundant Life Orphanages, and the Family to Family Africa Project. The chapter has also been a benefactor for the Howard University Endowment Chair, Scholarships to the United Negro College Funds, Scholarships to Local Church Youth Departments, and the Delta Research and Education Foundation.

www.rhpvacdst.com
Should be Empty:

E.M.B.O.D.I.

2025 Parental Consent Form

2025 Consent to Photograph