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11E- Applicant’s Agreement and Parents-Guardians Acknowledgement Form 1 | P a g e

reproduced, displayed or otherwise utilized by any party whatsoever without the express written consent of Delta Sigma Theta Sorority, Incorporated. Violation of Delta’s

intellectual property rights will be prosecuted to the full extent of the law.

DELTA SIGMA THETA SORORITY, INCORPORATED

A Service Sorority Founded in 1913

2021-2022

APPLICANT’S AGREEMENT AND PARENTS/GUARDIANS

ACKNOWLEDGMENT FORM

(Collegiate Applicants Only)

The collegiate applicant must complete this form if she agrees to inform her

parents/guardians of the membership intake process. Her parents/guardians

must acknowledge the agreement. The form must be typed and digitally

signed. It is acceptable for only one parent/guardian to sign the form.

ALL PAGES MUST BE SUBMITTED WITH THE MEMBERSHIP APPLICATION PACKET.

Name: ________________________________________________________________________

Present Address: _______________________________________________________________

Street

______________________________________________________________________________

City/State/Zip Code

______________________________________________________________________________

Telephone Number Email Address

Permanent Address: ____________________________________________________________

Street

______________________________________________________________________________

City/State/Zip Code

Applicant’s Agreement:

I have read Delta’s anti-hazing policy that is posted on its website and that is summarized in the Notice to

Applicant/Candidate/Pyramid Regarding Privilege and Responsibilities that I received as a part of my

application for membership packet I received from Delta. I understand that, to become a member of Delta, I

must abide by Delta’s membership intake process, including its anti-hazing policy. I also understand that, to

maximize its efforts to eradicate hazing and provide other reporting options, Delta wants to make my

parents/guardians aware that I have been accepted to participate in Delta’s membership intake process.

11E- Applicant’s Agreement and Parents-Guardians Acknowledgement Form 2 | P a g e

reproduced, displayed or otherwise utilized by any party whatsoever without the express written consent of Delta Sigma Theta Sorority, Incorporated. Violation of Delta’s

intellectual property rights will be prosecuted to the full extent of the law.

To ensure that my parents or guardians have been provided written information about Delta’s membership

intake process, including its no-hazing policy, I agree that I will:

• Provide my parents or guardians with the Parents/Guardians Acknowledgment Form (“Form”) that has

been included in my membership intake application packet. The Form informs my parents or guardians of

my plan to participate in the membership intake process and requires my parents or guardians to sign the

form acknowledging the following:

➢ his/her awareness of my plan to participate in the membership intake process;

➢ his/her receipt of summary of Delta’s anti-hazing policy;

➢ his/her awareness that I am not required to participate in any form of hazing to become a member

of Delta; and that

➢ he/she will report to Delta, to my college of university Dean or Greek Life officials, and/or to law

enforcement officials any suspicion that I am being hazed, or have been hazed, or have participated

in hazing activities.

By signing below, I agree that I have read and understand Delta’s anti-hazing policy and this

Applicant’s Agreement Parents/Guardians Acknowledgement Form. I also agree to comply with

Delta’s membership intake process, including its anti-hazing policy. I further agree to provide

information about my plans to participate in Delta’s membership intake process to my parents or

guardians, as reflected herein. I have had an opportunity to ask questions about the contents of this

form and agree to its terms and conditions.

Name of Applicant: ______________________________________________________________________

Signature of Applicant (digital): _____________________________________________________________

Date [Month Day Year]: __________________________________________________________________

Intended Chapter of Initiation ______________________________________________________________

Anti-Hazing Policy:

Delta Sigma Theta Sorority, Incorporated (“Delta”) has a zero-tolerance hazing policy. The policy is embodied

in documents disseminated to applicants/prospective members, including the Notice to

Applicant/Candidate/Pyramid Regarding Privilege and Responsibilities (“no hazing contract), which all

applicants are required to sign. The policy expressly prohibits all acts and forms of hazing, before, during and

after the Membership Intake Process. The prohibition covers

all hazing activities, whether physical,

mental, or emotional

, including,

but not limited to,

pre-initiation and/or underground activities (which is

anything in addition to or contrary to approved activities); paddling; beating; slapping; blindfolding; pushing;

depriving of sleep; pulling on clothes; pulling one’s hair; requiring the consumption of alcohol or drugs; forcing

or requiring the consumption of foods that an applicant/prospective member finds disagreeable; yelling;

humiliating; harassing; belittling; cursing; any morally degrading, illegal, or indecent action; requiring

applicants/prospective members, or newly initiated members to perform housework or homework for

members, or to “run errands.”

Any applicant who consents to hazing, who participates in hazing by allowing herself to be hazed, or who is

aware of hazing, but fails to report it shall be barred from membership in Delta.

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11E- Applicant’s Agreement and Parents-Guardians Acknowledgement Form 3 | P a g e

reproduced, displayed or otherwise utilized by any party whatsoever without the express written consent of Delta Sigma Theta Sorority, Incorporated. Violation of Delta’s

intellectual property rights will be prosecuted to the full extent of the law.

If you suspect that your daughter is being hazed or is participating in hazing, you too should report the

suspected hazing to designated Delta officials, the college or university where your daughter is a student,

and/or the police department in the area where the suspected hazing is occurring. The designated Delta

official is the regional director:

Central Region centralrd@deltasigmatheta.org

Eastern Region easternrd@deltasigmatheta.org

Farwest Region farwestrd@deltasigmatheta.org

Midwest Region midwestrd@deltasigmatheta.org

South Atlantic Region southatlanticrd@deltasigmatheta.org

Southern Region southernrd@deltasigmatheta.org

Southwest Region southwestrd@deltasigmatheta.org

Parents/Guardians Acknowledgment:

I understand that my daughter plans to participate in Delta’s membership intake process. I acknowledge that

I have received this copy of Delta’s anti-hazing policy; that I have read it and understand it; that I have

discussed it with my daughter; and that I am aware that my daughter is not required to participate in hazing

to become a member of Delta. I agree to report to Delta, to the college or university where my daughter is a

student, and/or to the police department suspicion that my daughter is being hazed or has been hazed. I also

understand and agree that any dispute regarding my daughter’s participation in Delta’s membership intake

process that is not resolved informally will be resolved by binding arbitration, which means not in a court of

law, with a judge and jury.

By signing below, I agree that I have read and understand this Parents/Guardians Acknowledgment

Form. I have had an opportunity to ask questions about the contents of this form. I acknowledge and

agree to the terms and conditions of this document.

Name of Parent/Guardian: ________________________________________________________________

______________________________________________________________________________________

Parent’s/Guardian’s Street Address

______________________________________________________________________________________

Parent’s/Guardian’s City/State/Zip Code

______________________________________________________________________________________

Parent’s/Guardian’s Phone Number Relationship to Applicant

______________________________________________________________________________________

Applicant’s Name

Signature of Parent/Guardian (digital): _______________________________________________________

Date [Month Day Year]: __________________________________________________________________

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