Annual Cotillion Program

Transcription

1 Annual Cotillion Program Application Packet DELTA SIGMA THETA SORORITY, INC. COLLIN COUNTY ALUMNAE CHAPTER

2 COTILLION OVERVIEW Cotillion Since the organization's founding, Delta Sigma Theta Sorority, Inc. has provided assistance to the challenges of people in the United States. Over the years, many programs addressing education, health, international development, and strengthening of the African American family were established. As a part of the organization's mission, Delta Sigma Theta provides public service initiatives through the Five-Point Program Thrust. In the spring of 2016, Collin County Alumnae Chapter will be hosting its eighth annual Cotillion Ball and would like to invite you to become a part of this legacy. Please take the time to review the enclosed application packet. We encourage you to apply and look forward to working with you. You may send questions to ccac.cotillion@gmail.com. Eligibility and Requirements Applicants must be a Senior for Debutante status or a Junior for Lady in Waiting status. Application must include: A completed and signed application including personal statements and parental consent forms One completed recommendation form from a school official/representative One completed recommendation form from a community leader ~ i.e. minister, employer, or member of Delta Sigma Theta Sorority, Inc. (not a family member) A copy of an official school transcript with a minimum 2.5 GPA based on a 4.0 grading scale A current photograph Mail all information to: Delta Sigma Theta Sorority, Inc. Attn: Cotillion Committee P.O. Box 10 Allen, TX Early Submission: June 30, 2015 Applicants are encouraged to submit by the early submission date, but no applications will be accepted after August 30, Selection and Notification Selected applicants will be mailed a Letter of Acceptance. The young ladies selected as Debutantes (Senior Class of 2016) and Ladies In Waiting (Junior Class of 2017) will be invited to a Welcome Reception to be held in September Please note any applicants submitting on the final submission date and then extend an invitation to the program will need to submit any initial payment(s) upon acceptance notification. 1

3 COTILLION APPLICATION Please complete each item. Type or print legibly in black ink. Check One: [ ] Debutante (12th Grade*) [ ] Lady In Waiting (11th Grade*) *During the upcoming academic school year Personal Information Name Address Street City State Zip Home Phone Date of Birth Cell Phone (mm/dd/yyyy) Mother/Guardian Mother/Guardian Address Home Phone (If different from above) Cell Phone Father/Guardian Father/Guardian Address Address Home Phone (If different from above) Cell Phone 2

4 ACADEMIC INFORMATION School GPA / (e.g. 3.5/4.0 scale) Student Involvement: School-Related Activities Grade Level (s) Offices Held, Accomplishments Honors/Awards/Achievements Grade Level (s) Church and Community Services Grade Level (s) Offices Held, Accomplishments Special Talents and Hobbies 3

5 COTILLION PERSONAL STATEMENTS Applicant s Name Please answer the following questions in reference to your personal and career aspirations. This program is highly competitive. We wish we had room for all applicants, however only those applicants with outstanding qualifications will be considered. Your responses will assist us in further assessing your application for the Cotillion Program. Attach additional sheets if necessary. 1. What field of study and/or career are you interested in pursuing? Please explain. 2. What personal goals and/or aspirations have you set for yourself? Please explain. 3. What ultimate contributions do you wish to make to society? 4. Describe briefly a female role model that you admire and why. 4

6 COTILLION PARENTAL CONSENT FORM Applicant s Name PARENT SECTION: This section is to be completed and signed by a parent/guardian. The names listed below will appear on all publications and publicity related to the Debutante or Lady in Waiting Candidate. Mother/Guardian Father/Guardian If the names listed above will not be presenting your Debutante Candidate at the Cotillion, please list the names and relationship to the Debutante Candidate of those who will. Female Male Relationship Relationship In case of emergency in parent/guardian s absence, please notify: Name Phone Address Parent/Guardian Statement: If selected, I give permission for my daughter to participate in the Cotillion Program. I understand that it will be my financial responsibility to provide the fees necessary to cover the cost of participation for my daughter and to meet all deadlines in order to ensure proper inclusions in Cotillion materials. This includes, but is not limited to, the non-refundable participation fee. Parent/Guardian Name: (Please Print) Signed: Date: / / 5

7 RECOMMENDATION FORM (For Teacher, Principal, or Counselor) The following student is seeking to become a participant in the s Cotillion. Please complete the following information and return to the applicant in a sealed envelope with a signature. Late applications will not be considered. Applicant s Name The above applicant has applied to participate in the of Delta Sigma Theta Sorority, Inc. Cotillion Program. The Cotillion Program asks that you serve as a character and/or academic reference. Please answer the following questions in reference to the applicant s qualifications. Thank you for your assistance. Attach additional sheets if necessary. 1. How long have you known the applicant and in what capacity? 2. Please give us your appraisal of the applicant in terms of the attributes listed below. Leadership Skills Maturity Level Cooperativeness Respectfulness Self-Confidence Attitude/Personality 3. Please feel free to make any additional comments about the applicant, which you believe would be helpful to the Cotillion Committee in considering her for the Cotillion Program. Recommender s Name Title Signed Date: / / (Recommender Signature) School Name City Address

8 RECOMMENDATION FORM (For Community Person Not Related to Applicant) The following student is seeking to become a participant in the s Cotillion. Please complete the following information and return to the applicant in a sealed envelope with a signature. Late applications will not be considered. Applicant s Name The above applicant has applied to participate in the of Delta Sigma Theta Sorority, Inc. Cotillion Program. The Cotillion Program asks that you serve as a character and/or academic reference. Please answer the following questions in reference to the applicant s qualifications. Thank you for your assistance. Attach additional sheets if necessary. 1. How long have you known the applicant and in what capacity? 2. Please give us your appraisal of the applicant in terms of the attributes listed below. Leadership Skills Maturity Level Cooperativeness Respectfulness Self-Confidence Attitude/Personality 3. Please feel free to make any additional comments about the applicant, which you believe would be helpful to the Cotillion Committee in considering her for the Cotillion Program. Recommender s Name Title Signed (Recommender Signature) Date: / / Address: City State Zip Phone

9 Statement of Qualifications I, confirm that I meet all the Cotillion participation criteria listed below and understand that I must maintain these standards throughout the Cotillion Season. 1. Must be a female Junior or Senior between the ages of 16 and Cumulative grade point average of 2.5 or better based on a 4.0 grading scale (verified by official transcript.) 3. Demonstrate interest and involvement in public service and community related activities. 4. Demonstrate goals, aspirations, and plans to pursue an education beyond high school. 5. Evidence of good moral character, which includes but not limited to: A. No record of poor discipline at school or in the community B. No criminal, misdemeanor, or court record of any kind C. Must not be a parent D. If you are currently pregnant or become pregnant during the Cotillion Season you will become ineligible and not allowed to continue participating in Cotillion activities and Cotillion presentation 6. Must not have previous or current employment in places of entertainment including bars, clubs, etc. 7. Must be able to commit to attending all necessary rehearsals and activities that occur throughout the Cotillion Season. 8. Upon acceptance, the potential participant must be willing to abide by further guidelines. Signed: Date: / / (Applicant Signature) Signed: Date: / / (Parent/Guardian Signature) 8

10 Agreement for Prospective Debutante or Lady in Waiting I, (print name), certify that the information provided in this application is complete, true, and accurate. I authorize the Collin County Alumnae Chapter of Delta Sigma Theta Sorority, Inc.'s Cotillion Co-Chairs and/or President and Vice Presidents to verify any information provided in this application. I understand that falsification of any information in this application will result in my dismissal from the Cotillion program and that any money received from me or on my behalf will NOT be refunded. I further understand that if I voluntarily withdraw from the Cotillion program any money received from me or on my behalf will NOT be refunded. Applicant s Signature Date I, (Print name), legal parent or guardian of (Print applicant s name), certify that the information provided in this application is complete, true, and accurate. I authorize the Collin County Alumnae Chapter of Delta Sigma Theta Sorority, Inc.'s Cotillion co-chairs and/or President and Vice Presidents to verify any information provided in this application. I understand that falsification of any information in this application will result in her dismissal from the Cotillion program and that any money received from her or on her behalf will NOT be refunded. I further understand that if she voluntarily withdraws from the Cotillion program or is removed from the Cotillion program for failure to adhere to guidelines and policies, any money received from her or on her behalf will NOT be refunded. Parent/Guardian Signature Date 9

11 RELEASE FROM LIABILITY Under the direction of Delta Sigma Theta Sorority s national Program Planning and Development Committee, Collin County Alumnae (CCAC) has implemented a chapter Risk Management Policy to ensure that all of our youth programs (including, but not limited to the Cotillion, Delta Academy, Delta GEMS and EMBODI) are administered consistently and in a manner that is in the interest of both the participating youth and Delta. (i.e., minimize any harm or injury to the youth as well as the probability of Delta incurring liability). All persons working with any of CCAC youth initiatives must adhere to this policy and complete the Youth Initiatives application and screening process. In consideration of being permitted to participate in the Delta Sigma Theta Sorority, Inc. Collin County Alumnae Chapter Cotillion Program, the undersigned, on behalf of myself, my heirs, executors, administrators, and assigns (collectively the Releasor ) hereby: 1. Remise, release, and forever discharge Delta Sigma Theta Sorority, Inc., Delta Sigma Theta Sorority, Inc., its officers, members, directors, shareholders, affiliates, agents, representatives, successors, assigns, and executors (collectively the Releasees ), of and from all actions, causes of action, claims, demands and damages, costs, expenses (collectively the Claims ) in respect of injury, loss, damage, or death to Releasors or associated property howsoever caused, arising by reason of or during participation and/or involvement in the Delta Sigma Theta Sorority, Inc. Collin County Alumnae Chapter Cotillion Program, and notwithstanding that any Claim may have been contributed to or occasioned by the negligence of any of the Releasees. 2. Indemnify and save harmless the Releasees from and against any and all liability incurred to any or all of them arising as a result of or in any way directly or indirectly connected to, or arising out of, participation in the Delta Sigma Theta Sorority, Inc. Cotillion Program. 3. Understand and acknowledge that Delta Sigma Theta Sorority, Inc. does not carry or maintain health, medical or disability insurance coverage for Releasor and therefore agrees to assume responsibility for such insurance coverage on the undersigned, heirs, executors, or administrators. 4. Agrees that in the event than any provision of this Release and Indemnity is held to be invalid or unenforceable by any court of competent jurisdiction, the invalidity or unenforceability of such provision will not affect the remaining provisions of this Release and Indemnity which shall continue to be enforceable. 5. Remise, release, and forever discharge the Releasees whatsoever, whether or not well founded in fact or in law, and from all suits, debts, dues, sums of money, accounts, reckonings, notes (or bonds), bills, specialties, covenants, contracts, controversies, agreements, promises, trespasses, damages, judgments, executions, claims and demands whatsoever, at law or in equity that Releasor ever had, now has, or that the Releasor hereafter may have against the Releasees hereby released by reason of any matter, cause or thing whatsoever up to and including the day of the date of this release in accordance with participation in Delta Sigma Theta Sorority, Inc. Cotillion Program. 6. Acknowledge and agree it is the specific intent and purpose of this instrument to release and discharge any and all claims and causes of action of any kind or nature whatsoever, whether known or unknown and whether specifically mentioned or not, which may exist or might be claimed to exist at or prior to the date of this release and undersigned specifically waives any claim or right to assert that any cause of action or alleged cause of action or claim or demand has been, through oversight or error or intentionally or unintentionally, omitted from this release. 7. Agree not to make claim or take proceedings against the Releasees or any other person or entity which may claim contribution or indemnity under the provisions of any statue or otherwise. 8. It is also understood that no legal action will be brought against of Delta Sigma Theta Sorority, Inc. or subsidiaries or authorized personnel by you or your child because of any matter directly or indirectly related to you and your child s participation in any session or events held by the Collin County Alumnae Chapter of Delta Sigma Theta Sorority, Inc. In witness whereof, the Releasor has executed this release on this day of, 2.The undersigned hereby acknowledges reading, understanding, and agreeing with the foregoing. Printed Name of Releasor Signature of Releasor Printed Name of Witness Signature of Witness 10

12 P.O. Box 10 Allen, TX Cotillion Photo Release Form Subject: CCAC Debutante Cotillion Program (Season) Permission to Use Photograph Location: Collin County, TX I grant to of Delta Sigma Theta Sorority, Inc., its representatives and contractors the right to take photographs of (Printed Name) and my property in connection with the above-identified subject. I authorize of Delta Sigma Theta Sorority, Inc., its contracted businesses to copyright, use and publish the same in print and/or electronically in connection with the publication or promotion of the Cotillion Program or chapter sponsored events open to the community. I agree that of Delta Sigma Theta Sorority, Inc. may use such photographs of me with or without my name and for any lawful purpose, including publicity, illustration, advertising, and internet content. I have read and understand the above: Participant s Printed Name Signature Date: Legal Guardian s Printed Name Signature Date: 11