Delta Sigma Theta Sorority, Inc. Hayward-Tri-City Alumnae Chapter Scholarship Application PO Box 4113, Hayward, CA 94540

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1 Schlarship Applicatin Histry f Delta Sigma Theta Srrity, Inc. and Delta Sigma Theta Srrity, Inc. was funded at Hward University in Washingtn, D.C. n January 13, 1913 by twenty-tw African American undergraduate wmen. These wmen wanted t use their cllective strength t prmte academic excellence and lead scial actin initiatives n behalf f the African American cmmunity. Delta Sigma Theta Srrity, Inc. (the Srrity) is a private, nn-prfit rganizatin whse purpse is t prvide assistance and supprt thrugh established prgrams in lcal cmmunities thrughut the wrld. As a sisterhd f mre than 200,000 predminately Black cllege educated wmen, the Srrity currently has ver 900 chapters lcated in the United States, England, Japan (Tky and Okinawa), Germany, the Virgin Islands, Bermuda, the Bahamas and the Republic f Krea. The majr prgrams f the Srrity are based upn the rganizatin's Five Pint Thrusts f: Ecnmic Develpment, Educatinal Develpment, Internatinal Awareness and Invlvement, Physical and Mental Health, and Plitical Awareness and Invlvement. The f Delta Sigma Theta was chartered in 1990 t serve the cities f Hayward, Fremnt, Newark and Unin City. Our prgrams include, but are nt limited t, the fllwing: Δ Dr. Betty Shabazz Delta Academy a mentring prgram fr adlescent girls aged 9-13 years Δ Dr. Jeanne L. Nble Delta G.E.M.S. Institute a mentring prgram fr teenage girls aged years Δ E.M.B.O.D.I. A mentring prgram fr African American males ages Δ Vter registratin and educatin activities Δ Music at the Museum an annual fundraiser t supprt ur schlarships and ther cmmunity service prgrams Δ Supprt fr varius cmmunity rganizatins including Abde Services and I Can Fly Schl in Kenya ELIGIBILITY REQUIREMENTS FIRST TIME APPLICANTS must meet all criteria: Δ Be a high schl senir, have received a GED, r be currently enrlled in r accepted by a tw-year r fur-year cllege r university; and Δ Have a minimum verall grade pint average f 2.75 n a 4.0 scale; and Δ Be a resident f, r attend schl in, Hayward, Fremnt, Newark r Unin City r ne f ur secndary service areas (Castr Valley, Dublin, Pleasantn, San Leandr, r San Lrenz); and Δ Demnstrate active vlunteer service in the African American cmmunity. NOTE: If yu d nt reside r attend schl in Hayward, Fremnt, Newark r Unin City, r in ne f ur secndary areas (Castr Valley, Dublin, Pleasantn, San Leandr, r San Lrenz), yu will need a referral frm a current member f Hayward -Tri-City Alumnae Chapter in rder t be cnsidered fr this schlarship. PRIOR SCHOLARSHIP RECIPIENTS must meet all criteria: Δ Be currently enrlled in a tw-year r fur year cllege r university, and Δ Have a minimum verall grade pint average f 3.0 n a 4.0 scale; and Δ Have received a schlarship fr n mre than 3 years. Page 1 f 5

2 Schlarship Applicatin APPLICATION REQUIREMENTS FIRST TIME APPLICANTS must submit the fllwing: Δ A cmpleted schlarship applicatin; Δ Three persnal letters f recmmendatin. Each letter must be written n the fficial letterhead f the rganizatin: Current High Schl Students: ne letter each frm a: (a) cunselr; (b) teacher; and (c) representative f a cmmunity service rganizatin. High Schl Graduates (nt currently enrlled in cllege): (a) ne letter frm a representative f a cmmunity service rganizatin and (b) tw letters, frm a cmbinatin f the fllwing: clergy, emplyer, a representative f a secnd cmmunity service rganizatin, r any adult wh has knwn yu fr five years r lnger. Current Cllege Students: ne letter each frm a: (a) current prfessr, academic cunselr, r dean; (b) representative f a cmmunity service rganizatin; and (c) clergy, representative f a secnd cmmunity service rganizatin, secnd prfessr, r an emplyer. Δ A cpy f the Letter f Intent r Acceptance Letter frm the cllege r university yu plan t attend. This is nly required if yu are nt currently enrlled in cllege; Δ Yur mst recent fficial academic transcript. The registrar must send the transcript directly t yu and yu must prvide it t us unpened. We will nt accept student cpies r ther unfficial transcripts. We will nt accept previusly pened envelpes; Δ Tw shrt essays f wrds each in size 12 pt. fnt, duble spaced. The essays shuld address the fllwing tpics: Essay 1: Describe yur cllege and career bjectives, yur leadership skills and yur vlunteer service in the African American cmmunity. Please prvide specific examples fr each f the three areas. Essay 2: Describe a challenge yu had t vercme t achieve ne f yur gals. Prvide specific example f the steps yu tk t vercme the challenge. Δ A 3X5, wallet-size r passprt clr pht (head sht) Nte: Phts will nt be returned; and, Δ A signed Phtgraph and Vide Authrizatin and Release Frm. PRIOR SCHOLARSHIP RECIPIENTS must submit the fllwing: Δ A cmpleted schlarship applicatin; Δ Yur mst recent fficial academic transcript. Registrar must send the transcript directly t yu and yu must prvide it t us unpened. We will nt accept student cpies r ther unfficial transcripts. We will nt accept previusly pened envelpes; Δ A 3X5, wallet-size r passprt clr pht (head sht) Nte: Phts will nt be returned; and, Δ A signed Phtgraph and Vide Authrizatin and Release Frm. Page 2 f 5

3 Schlarship Applicatin Applicatin Instructins: Δ Type r print yur respnses. Δ Cmplete all sectins. Insert N/A in sectins that d nt apply t yu. Δ Sign the applicatin and Phtgraph and Vide Authrizatin and Release Frm If yu have questins, please cntact Snya Sctt and Lydia Wylie, Schlarship Cmmittee C-Chairs at schlarship.htc@gmail.cm Student Prfile Name: Street Address: City: State: Zip: Address: Hme Number: Cell Number: Male Female Are there members f Delta Sigma Theta Srrity, Inc. in yur family? (Check all that apply) Mther Sister Grandmther Aunt Nne Fr New Applicants Only D yu reside in r attend schl in Hayward, Fremnt, Newark r Unin City? Y N D yu reside in r attend schl in Castr Valley, Dublin, Pleasantn, San Leandr, r San Lrenz? Y N If yu answered n t bth f the abve questins, yu will need a referral frm a current member f the. Enter her name here: Fr Previus Applicants Only Have yu received a schlarship frm the? Y N If yes, which year(s): Academic Prfile Name f current High Schl r Cllege (include the city and state): Classificatin: Freshman Sphmre Junir Senir GPA ( n a 4.0 scale): Majr: Graduatin Date: Please list any extracurricular activities (Include ffices held, awards received, hnrs, clubs, cmmittees, athletics, etc.) Yu may use an additinal infrmatin sheet if necessary. Amunt f time Dates f Awards /Other Activity Office held per week Participatin recgnitin Page 3 f 5

4 Schlarship Applicatin Please list all cmmunity, public, vlunteer and/r church service activities. Yu may use an additinal infrmatin sheet if necessary. Dates f Name f rganizatin Activity Awards/recgnitins participatin Name f Emplyer: Address: Jb Descriptin: Emplyment Prfile Phne: Dates f Emplyment: Deadline A cmplete applicatin packet, in ne envelpe that includes all required materials, must be pstmarked by February 28, Selected first time applicants will be interviewed in March Applicatins must be mailed t: Delta Sigma Theta Srrity Inc. P. O. Bx 4113 Hayward, CA Attn: Schlarship Cmmittee INCOMPLETE PACKAGES AND PACKAGES POSTMARKED AFTER FEBRUARY 28TH WILL NOT BE ACCEPTED. Disclsure I hereby certify that the infrmatin prvided in this applicatin is, t the best f my knwledge, true and crrect. I have nt knwingly withheld any facts r circumstances that wuld jepardize acceptance f this applicatin. In additin, all infrmatin cntained in this applicatin may be used by fr marketing purpses. Student Signature: Date: Page 4 f 5

5 Schlarship Applicatin PHOTOGRAPH and VIDEO AUTHORIZATION AND RELEASE FORM Prgram Year: September 2014 June 2015 I,, give permissin fr f Delta Sigma Theta, Incrprated (the Chapter ) t publish n the Internet r media still phtgraphs r mving images, including, if applicable, any sund recrdings accmpanying the images ( Images ) taken f me during my applicatin, interview, and/r acceptance f the Chapter s schlarship, during the September 2014 June 2015 prgram year, withut payment r any cnsideratin and withut ntifying me. I understand and agree that these Images will becme the prperty f the Chapter, which shall have cmplete wnership f the Images. I hereby irrevcably authrize the Chapter t publish r distribute these Images fr the purpse f publicizing the Chapter s schlarship recipients, including the Chapter s Yuth Initiative Prgrams, r fr any ther lawful purpse. In additin, I waive any right t inspect r apprve the finished prduct wherein my likeness appears. Additinally, I waive any rights t ryalties r ther cmpensatin arising ut f r related t the use f the Images. I hereby hld harmless and release and frever discharge the Chapter and any f its fficers and members; Delta Sigma Theta Srrity, Incrprated; its fficers; natinal executive bard; emplyees; members; representatives; agents; and assigns frm any and all claims, csts, suits, actins, judgments, and expenses which I, my heirs, representatives, executrs, administratrs, r any ther persns acting n my behalf have r may have by any reasn f the use f the Images. This release specifically includes, withut limitatin, a cmplete release and discharge f any liability by virtue f any editing, distrtin, alteratin, r ptical illusin, whether intentin, r therwise, that may ccur r be prduced in the taking f r editing f said Images, unless it can be shwn that such was maliciusly caused, prduced, and published slely fr the purpse f subjecting me t cnspicuus ridicule, scandal, reprach, scrn, and indignity. I d hereby give my cnsent withut reservatin t the frging. Student Signature Date Print Name If the abve named student is under the age f 18, a parent r legal guardian must sign belw. Parent r Legal Guardian Signature Date Print Name Page 5 f 5