“developing effective leadership through …...excellence. the delta gems program, formerly known...

“DEVELOPING EFFECTIVE LEADERSHIP THROUGH ACHIEVING,

GROWING, AND EMPOWERING MYSELF SUCCESSFULLY”

2019-2020Delta Sigma Theta Sorority, Inc.

Dr. Jeanne L. Noble GEMSNew Member Application

SPONSORED BY

Huntsville Alumnae Chapter Delta Sigma Theta Sorority, Inc.

P.O. Box 3373 Huntsville, Alabama 35810

[email protected]

Delta GEMS Huntsville Alumnae Chapter, Delta Sigma Theta Sorority, Inc. ________________________________________________________________________

2019-2020 Delta GEMS New Member Application | Page 1

Huntsville Alumnae Chapter

Delta GEMS Program Information

Delta Sigma Theta Sorority, Inc. is a non-profit nationwide organization, whose purpose is to provide service and programs to promote human welfare. The Delta Growing and Empowering Myself Successfully (GEMS) program honors the 12th National President of Delta Sigma Theta Sorority, Inc., Dr. Jeanne L. Noble. Dr. Noble was a legendary pioneer in the field of education. Since the inception of Delta GEMS in 2004, the program has served as a catalyst for young African American women between the ages of 14 and 18 in grades 9 through 12 to enhance their abilities in order to achieve academic excellence. The Delta GEMS program, formerly known as Delteens, is a youth community service program of the Huntsville Alumnae Chapter, which began in the early 50’s. The Delta GEMS program is an extension of the Dr. Betty Shabazz Delta Academy program, which assists young females ages 11-14 with academics and self-esteem.

The goals for Delta GEMS are: ➢ To instill the need to excel academically➢ To provide tools that enable girls to sharpen and enhance their skills to achieve high levels of

academic success➢ To assist girls in proper goal setting and planning for their futures, high school and beyond➢ To create compassionate, caring, and community minded young women and actively involve

them in service advocacy and community service opportunities

The mission of the Delta GEMS Advisory Committee is to provide young ladies with a firm structural program that will enhance their self-esteem, academic achievement, leadership skills, and cultural awareness. This, in turn, will provide them with the opportunity to develop emotionally, socially, and intellectually. It will also help young ladies be prepared to take an active role in their success as they face the challenges of the world.

The goals and objectives of the Delta GEMS Advisory Committee will be accomplished through a series of workshops and community service activities using the following frame work:

➢ Scholarship (Academic Excellence)➢ Sisterhood (Self Esteem, Health Awareness & Leadership)➢ Showing Me the Money (Financial Awareness)➢ Service (Social Responsibility Obtained through Community Service)➢ Infinitely Complete (The Rites of Passage)

The Delta GEMS logo is likened to a gemologist who can see, through the use of certain tools, the hidden treasure in unpolished jewels. Delta GEMS uses the polished jewels as a symbol of the facets that shine and glow within our young African-American women.




Delta GEMS Membership Criteria for Membership: Membership into the Delta GEMS program is held once a year. The following criteria will be used to determine eligibility:

➢ Must be between the ages 14 - 18 entering or attending high school in the fall (grades 9 - 12)➢ Must be in the service area of Huntsville City, Madison County, and Madison City, which

includes, but is not limited to the following:o Huntsville City Schools:

▪ Butler High School▪ Columbia High School▪ Grissom High School▪ Huntsville High School▪ Johnson High School▪ Lee High School▪ New Century Technology High School

o Madison County Schools:▪ Buckhorn High▪ Hazel Green High▪ Madison County High▪ New Hope High▪ Sparkman High

o Madison City Schools:▪ Bob Jones High School▪ James Clemens High School▪ The Academy

o Huntsville Madison Private Schools:▪ Madison Academy▪ Randolph School▪ Westminster Christian Academy▪ Whitesburg Christian Academy▪ Union Chapel Christian Academy

➢ Completed application➢ Typed Essay briefly describing yourself and future goals➢ One (1) letter of recommendation from one of the following (who is also not a family member):

✓ Teacher or Guidance Counselor✓ Employer✓ Minister /Church Leader✓ A Sponsor /Advisor of any affiliation/organization✓ A member of a Greek sorority or fraternity

➢ Signed “Agreement to Participate” by applicant and parent




All items are to be submitted together as one packet. If accepted for membership, you and a parent must attend the orientation program.

Activities: The following activities are included, but are not limited to the organization’s participation:

Orientation Presentations and Seminars College High School Senior Day Black History Observance Community Service Academic Testing Workshops, Updates, and Study Sessions Christmas Party Field Trips Awards Program Rites of Passage

Code of Conduct: Membership in the Delta GEMS organization requires a strong level of commitment and responsibility. All members are to adhere to a “Code of Conduct,” which consists of policies and procedures that govern the organization. The Code of Conduct and sanctions for violating the Code of Conduct must be reviewed and signed by the participant and parent.

Delta GEMS Important Dates and Deadlines

Selection Process: The selection process consists of a review of completed applications by the Delta GEMS Advisory Committee. Returned applications and recommendation letters must be postmarked no later than Friday, August 23, 2018. Completed applications should be sent to the following address:

Attn: Delta GEMS Huntsville Alumnae Chapter

Delta Sigma Theta Sorority, Inc. P.O. Box 3373

Huntsville, Alabama 35810




All required application documents are to be submitted together as one application packet. If an application packet does not contain all items listed as criteria for membership, it will be considered incomplete. Application packets received after the postmark date will not be reviewed.

Any questions may be sent to [email protected].

If selected for membership: New members must participate in the Orientation program currently scheduled for Sunday, September 8, 2018. The specific time and location will be provided upon acceptance into the program. Please wear a black dress or black suit and have at least one parent/guardian or family member present at the Orientation program.

If selected to become a member of the Delta GEMS program sponsored by the Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc., I understand and agree to the following guidelines and expectations:

➢ Participation in the Orientation program is mandatory.➢ Involvement and participation in all Delta GEMS activities are governed under the auspices of

Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc., Delta GEMS Code of Conduct,Officers, and Committee Chairpersons.

➢ Membership is strictly voluntary and requires a strong level of commitment. A minimum of 80%participation is required for all meetings, events and activities. GEMS that are seniors and don'tmeet this criteria will not be eligible for the GEMS Scholarship all others will not be asked toreturn the following year.

➢ Members in good standing may continue membership until high school graduation. This iscontingent upon completion of a renewal application each year following the first year ofparticipation.

➢ Attendance at all regularly scheduled meetings (currently one Saturday in each month from 2:00pm - 4:00 pm, occasional workshops/community service outside of regular meeting time isexpected.

➢ Appropriate behavior becoming of a lady should be exemplified at all times.➢ Although meetings are closed to participants and sorority members, parents are welcome to sit

outside meeting areas during meetings.




PLEASE KEEP THIS AND THE PRECEDING PAGES FOR YOUR OWN INFORMATION.




Delta GEMS

New Member Application

Name: _______________________________________________________________________________ Last First Middle

Age: ______________________ DOB: _____________________________________________________

Home Phone: ______________________________ Cell Phone: ________________________________

Address: _____________________________________________________________________________

City: ________________________________ State: ____________________ Zip: _________________

Applicant Email Address: ________________________________________________________________

Current School: _______________________________________________________________________

Grade Level: _________________________________ T-shirt size (adult)________________________

School attending in the fall: _____________________________________________________________

Do you work part-time? Y _____ N _____

If so, do you work on Saturday? Y _______ N__________ Hours: ________

If no, do you have plans to get a job? Y ________ N _______

Activities & Honors: Describe your involvement in extracurricular school activities and community service. Provide a brief overview of any special awards received for academics, philanthropic, athletic and/or achievements.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________




Parent/Guardian’s Name: _______________________________________________________________

Address: _____________________________________________________________________________

City: __________________________________________ State: ____________ Zip: ______________

Primary Contact #: __________________________ Secondary Contact #: ________________________

Parent Email Address: __________________________________________________________________

Is your mother a member of Delta Sigma Theta Sorority, Inc.? Y ___________ N ____________

Have you participated in another Delta GEMS program? Y ___________ N ____________

Do you currently have a relative participating in a Delta GEMS program? Y _______ N ___________

Have you participated with Delta Academy? Y ___________ N ____________

Have you participated in any Delta Sigma Theta sponsored activities (i.e., Jabberwock, etc.)? Y __ N __

On a separate sheet in 250 words or less, briefly describe yourself and future goals. Also, tell us what you can contribute to the program and what you hope to gain from the Delta GEMS program. Your essay must be typed and submitted with your application.

************************************************************************************

* AGREEMENT TO PARTICIPATE

We have read and agree with all the information provided for the Delta GEMS program sponsored by Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc. If (our/my) child is selected for membership into the Delta GEMS program, please accept (our/my) signature(s) as (our/my) consent to have her participate. You may count on (us/me) for support and assistance whenever appropriate.

Applicant Signature: ___________________________________________ Date: ___________________

Parent Signature: ______________________________________________ Date: __________________




DELTA GEMS RECOMMENDATION FORM Huntsville Alumnae Chapter

Delta Sigma Theta Sorority, Inc. P.O. Box 3373

Huntsville, Alabama 35810 (Must be submitted with application & postmarked by August 23, 2018)

Applicant’s Name: _____________________________________________________________________

Your Name: __________________________________________ Phone Number: __________________

Relationship to Applicant: _______________________________________________________________

How many years have you known the applicant? _____________________________________________

Recommendation:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________




PARENTAL AFFIRMATION

I, ________________________________________, Parent/Guardian, under penalty of perjury, do hereby affirm to the Huntsville Chapter of Delta Sigma Theta Sorority, Incorporate that I authorize participation of ________________________________________, Participant Minor Child, in the Delta GEMS youth initiative program (including planned activities), and that I have the legal authority to provide my consent and authorization for such participation.

Printed Name: _______________________________________________

Signature: ___________________________________________________

Date: _______________________________________________________

Relationship to Child: __________________________________________

************************************************************************************* WAIVER AND RELEASE

I, __________________________________________, Parent/Guardian, on behalf of ______________________________________ (“Participant Minor Child”) do hereby release, waive, discharge, covenant not to sue and agree to hold harmless Delta Sigma Theta Sorority, Incorporated (“Delta”), its officers, National Executive Board, employees, members, local chapters, representatives, agents, affiliates, and assigns (collectively “Releasees”), from any and all claims, demands, and actions of any and every kind directly or indirectly arising out of, or relating in any respect to Participant Minor Child’s participation in the Delta GEMS program.

My waiver and release of all claims, demands, actions, and liability shall include without limitation, any injury, illness, death, property damage or loss to the Participant Minor Child, which may be caused by any act, or failure to act, by the Releasees, unless such injury, illness, death, property damage or loss is a direct result of the willful misconduct of any Release.

I understand that, without limitation of the foregoing, neither Delta, nor the Program, shall be liable and each is hereby released from all claims that may arise from loss or damage to the Participant Minor Child’s personal property.

Parent/Guardian Signature: _______________________________________

Date: ___________________________




MEDICAL INFORMATION

Name: _______________________________________________________________________________

Age: _________________________________ DOB: __________________________________________

Home Phone: _____________________________ Cell Phone: _________________________________

Address: _____________________________________________________________________________

City: _____________________________________ State: ______________ Zip: __________________

Emergency Contact: ____________________________________________________________________

Hospital Preference: ____________________________________________________________________

Medications: __________________________________________________________________________

Allergies (Food/Medication/Environmental): ________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Other Pertinent Medical Information (severe illnesses or accidents; significant health history, conditions communicable illness, or restrictions that may affect child’s participation in Delta GEMS program):

____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________ Upon review of above responses by the Delta GEMS Committee, additional medical documentation may need to be completed.




PARTICIPATION PERMISSIONS

Photo Release

I, as the parent or legal guardian, grant permission for the Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc. to include my daughter, ______________________________, in pictures taken at Delta GEMS activities held throughout the year. I also give permission for the Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc. to publish on the Internet or media still photographs or moving images, including, if applicable, any sound recordings accompanying the images taken of my child at Delta GEMS events without payment or any consideration and without notifying me.

I understand and agree these images will become the property of the Huntsville Alumnae Chapter, which shall have complete ownership of the images. I hereby irrevocably authorized the Huntsville Alumnae Chapter to publish or distribute these images for the purpose of publicizing the Chapter’s programs, including the Delta GEMS program or for any other lawful purpose. In addition, I waive the right to inspect or approve the finished product wherein my child’s likeness appears. Additionally, I waive any rights to royalties or other compensation arising out of or related to the use of the images.

I hereby hold harmless any release and forever discharge the Huntsville Alumnae Chapter and any of its officers and members; Delta Sigma Theta Sorority, Incorporated; its officers; National Executive Board; employees; members; representatives; agents; and assigns from any and all claims, costs, suits, actions, judgments, and expense which my child, his/her behalf have or may have by reason of the use of the images. This release specifically includes, without limitation, a complete release and whether intentional or otherwise, that may occur or be produced in the taking of or editing of said images, unless it can be shown that such was maliciously caused, produced and published solely for the purpose of subjecting my child to conspicuous ridicule, scandal, reproach, scorn and indignity.

I hereby certify that I am the parent/guardian of ______________________________, and do hereby give my consent without reservation to the foregoing on behalf of my child.

Parent / Guardian Signature: ______________________________________________

Date: ____________________________________________




Workshop Permission

I grant my daughter, ________________________________, permission to participate in the workshops presented to Delta GEMS. I understand that most of the workshops are listed in the Delta GEMS yearly calendar.

Parent / Guardian Signature: ______________________________________

Date: ____________________________________________

If you have any objectionable topics, please list them and sign below:

_____________________________________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Parent / Guardian Signature: _____________________________________________

Date: _______________________________________________

Field Trip Permission

As the parent/guardian of ______________________________________, I hereby give consent for her to attend field trips with Delta GEMS sponsored by the Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc. My daughter and I understand that she is to comply with all rules and regulations established by all representatives of Delta Sigma Theta Sorority, Inc.

I understand that precautions will be taken to ensure my daughter’s safety. I, therefore, will not hold the Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc. or any representatives of Delta Sigma Theta Sorority, Inc. responsible for any complication, injury, or illness experienced by my daughter.

Field trips are subject to change, and notification is at the discretion of Huntsville Alumnae Chapter of Delta Sigma Theta Sorority, Inc.

Parent / Guardian Signature: __________________________________________

Date: _______________________________________________




CODE OF CONDUCT FOR YOUTH PARTICIPATING IN YOUTH INITIATIVES PROGRAM

1. Respect all participants (other youths and adult volunteers) by not using foul, hurtful or obscenelanguage or engaging in physical violence, bullying (including cyber-bullying) or other aggressivebehaviors that threaten the safety of others.

2. Respect the property rights of other. This means do not damage or deface the building or propertywithin the building where chapter activities are held; do not damage or take the personal propertyof any other participant or volunteer; and do not use Delta’s name or any symbol or logo (Delta’sintellectual 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.

Sanctions for Violating Code of Conduct

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-day suspension from program 4th 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 2nd Time: 1-day suspension from program 3rd Time: 1-week suspension from program 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.




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.

_______________________________________ ______________________________________ Print Name (Participant) Signature

Date___________________________________

**************

I have read and understand the Code of Conduct and sanctions for violating the Code of Conduct. I understand that my daughter’s compliance with the Code of Conduct is a condition of her participation in the Delta GEMS program. I agree that the sanctions for violating the Code of Conduct are reasonable and will help my daughter comply.

_______________________________________ ______________________________________ Print Name (Parent) Signature

Date___________________________________




YOUTH PICK-UP AUTHORIZATION FORM

I authorize the persons listed below to pick-up my daughter, __________________________________, from the Delta GEMS youth initiative program. For my daughter’s safety, I understand that all authorized persons on the list below will be asked to show photo identification before my daughter is released to them; therefore, I will notify all authorized persons of this requirement so that they will have photo identification with them when they arrive to pick-up my daughter. (Please include names of either parents or guardians on list below).

Name _________________________________________ Relationship____________________________

Home Phone________________ Work Phone _________________ Cell Phone _____________________





Otherwise, I confirm my daughter, __________________________________, has a valid driver’s license and will be responsible for driving herself to and from meetings.

By signing below, I verify that I have read and agree to the Student Pick-Up policies described above and authorize the Huntsville Alumnae Chapter to release my daughter to the persons listed above. I also agree to notify the Huntsville Alumnae Chapter in writing of any changes to the above list of authorized persons. If no one is listed above, I verify that my daughter will be responsible for driving herself to and from the Delta GEMS youth initiative program.

Mother/Guardian Signature ___________________________________ Date _______________

Father/Guardian Signature ____________________________________ Date _______________

“developing effective leadership through …...excellence. the delta gems program, formerly known...

Documents