Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

Do you know an African-American male ranging in age from 14-18 who would benefit from
positive manhood training anchored in high expectations? Join Delta Rho Omega Chapter of
Alpha Kappa Alpha Sorority, Incorporated for their Biennial Rites of Passage Ceremony and
Beautillion program.
African-American males and their female escorts will participate in monthly life-skills
workshops, including, but not limited to:
Leadership training
Financial planning
Social etiquette

Community involvement
College preparation
Culture and the arts

Before the young men are presented in a non-traditional cotillion for males, they will undergo a
ceremonial Rites of Passage adapted from West African tradition, marking their transition from
adolescence to young adulthood. This eight-month journey culminates in a formal black-tie
ceremony to present the participants to the community in the Spring of 2012.
Alpha Kappa Alpha Sorority, Incorporated, founded in 1908 at Howard University in
Washington, D.C., was this nations first sorority established for African-American college
trained women. The organization continues to strive for excellence under its current
international Global Leadership through Timeless Leadership initiatives: Emerging Young
Leaders, Health, Global Poverty, Economic Security, Social Justice and Human Rights and
External & Internal Leadership. Throughout its 64 years, Delta Rho Omega Chapter of Alpha
Kappa Alpha Sorority, Incorporated has provided services to the Brooklyn community through
programs that benefit children, young adults, seniors and families. Since 1990, Delta Rho
Omega has adopted the Rites of Passage and Beautillion as one of its premier programs. The
program has consistently continued to provide the participants with an invaluable learning
experience that is rooted in tradition and whose purpose is to raise consciousness, solve
problems and effect change.
If you or someone you know would like to be a part of this life-changing experience or have
any questions, please contact Ms. Karen St. Hilaire at 646-637-7576 or email
drobeautillion2012@yahoo.com.

Dawn M. Baskerville,
President

Zena M. Mine,
Beautillion Chairman

Rites of Passage and Beautillion 2011-2012, Page 1 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

Application Criteria 2011-2012

* Applicant must be between the ages of 14-18 years old

* Application must be completed and signed by the parent or sponsor
* A completed application packet includes the following
Parent/Sponsor Information Form pages 3-4
Completed and signed application pages 5-7
Completed recommendation form from a school official, church leader
or community leader page 8
Signed Beautillion Agreement page 9
Signed media release form page 10
Medical Release Form page 11-12
$100.00 Participation fee (personal check, money order or cashiers
Check made payable to: Ivy Rose Foundation, Inc)

* Application Deadline - September 27, 2011

Mail completed application packet and participation fee to:
Karen St. Hilaire
1358 Prospect Place
Brooklyn, New York 11213
Karen.StHilaire@gmail.com
646-637-7576
Alpha Kappa Alpha Sorority, Incorporated
Delta Rho Omega Chapter

Rites of Passage and Beautillion 2011-2012, Page 2 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

PARENT/SPONSOR INFORMATION
Please completely fill in the information requested below.
Please print using blue/black ink.
Childs name: ________________________________________________________
Parents Information:
Full Name: ___________________________________________________
Address: ______________________________________________________
______________________________________________________________
Telephone: (h) _______________(c) _______________(w)____________________
Email: _______________________________________________________________
Please check one: (If you have more than one child participating, please complete a separate
form for each child)
Your child will be participating as a Beau ____
as an Escort ____
How did you learn about this program? Please check all that apply.
Former participant

_____

Friend

_____

Alpha Kappa Alpha member _____ Name________________________

Other

_____ Name________________________

Why do you want your child to participate? _______________________________

_______________________________________________________________________
_______________________________________________________________________
Rites of Passage and Beautillion 2011-2012, Page 3 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

Do you agree with and understand that you are responsible for the transportation of your child
to and from workshops and program activities? Yes__ No__
Do you agree with and understand that your child will be engaged in a mentor/mentee
relationship with an adult for the duration of the program? Yes__ No__
Do you agree with and understand that your child will participate in a Rites of Passage
ceremony and culminating event as part of the program? Yes__ No__
Do you agree with and understand that you are responsible for the cost of your childs attire for
the culminating experiences, required registration fee and other fundraising requirements of
the program? Yes__ No__

Please list below any concerns you may have regarding the information provided
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
___________________________________________

*Please note*
All participants are encouraged to assist in the 2012 Beautillion fundraising activities.
Fundraising activities include the selling/purchase of a round table (10 tickets) for the
culminating award ceremony, journal advertisement and raffle books.

Parent/Sponsor Signature _____________________________________

Relation to applicant: _________________________________________
Date: ________________________________________________________

Rites of Passage and Beautillion 2011-2012, Page 4 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

2011-2012 PARTICIPANT APPLICATION

Please completely fill in the information requested below.
Please print using black ink.
Childs Full Name: ___________________________________________________
Address: ____________________________________________________________
____________________________________________________________
Telephone: (h) __________________________ (c) __________________________
School: ___________________________________ Grade: ___________________
Email: _______________________________________________________________
Date of Birth: _________________________________________________________
Community & School activities:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Hobbies: _____________________________________________________________
Favorites:
Movie ________________________________________________
Author ________________________________________________
Music, song, entertainer _________________________________

Rites of Passage and Beautillion 2011-2012, Page 5 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

List three things that make you special or describe you:

1. ______________________________________________________________
2. ______________________________________________________________
3. ______________________________________________________________
Who has been a role model for you? Why?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
List the goals you have for yourself in the coming year:
1. ______________________________________________________________
2. ______________________________________________________________
3. ______________________________________________________________

What is the greatest challenge you have had to overcome?

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________

Rites of Passage and Beautillion 2011-2012, Page 6 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

What are your expectations of the 2011 Beautillion program?

_____________________________________________________________________________________
_____________________________________________________________________________________
________________________________________________________________
______________________________________________________________________________

Why would you like to become a participant in the Beautillion?

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
__________________________________________________
Applicant Signature: ________________________________ Date: ___________________
Do not write below this line
--------------------------------------------------------------------------------------------------------------------Amount Received __________________________ Date Received______________________
Received by________________________________
Cash_____ Money Order_____ Check(#)_____
Notes:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Rites of Passage and Beautillion 2011-2012, Page 7 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

2011-2012
Beautillion Recommendation Form

Applicants Name: __________________________________________________________

How long have you know the applicant? ______________________________________
How do you know the applicant?
_____________________________________________________________________________
Based on your experience with the applicant, please fill in the following:
Outstanding

Good

Fair

Poor

Maturity and
Judgment
Leadership
Ability to get
along with others
Motivation and
Initiative
Personal Integrity
Dependability
Please use the space below to make additional comments or recommendations (use a separate
sheet if needed)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Signature:
Print:
Organization:
Phone:

________________________________________________
________________________________________________
________________________________________________
___________________________ Date _______________

Rites of Passage and Beautillion 2011-2012, Page 8 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

Beautillion Participation Agreement

I, _____________________________________________________ (Print Name), certify that the

information provided in this application is accurate. I authorize the Delta Rho Omega Chapter
of Alpha Kappa Alpha Sorority, Inc. Beautillion committee 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 Beautillion 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 Beautillion program,
any money received from me or on my behalf will NOT be refunded.

____________________________________
Applicants Signature

______________________
Date

____________________________________
Parents Signature

______________________
Date

Rites of Passage and Beautillion 2011-2012, Page 9 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

Permission to Use Photograph

I _______________________________________________ grant to Alpha Kappa Alpha Sorority,
Inc, Delta Rho Omega chapter and its representatives the right to take photographs of me in
connection with the 2011-2012 Rites of Passage-Beautillion and I authorize Alpha Kappa Alpha
Sorority, Inc, Delta Rho Omega chapter, its assigns and transferees to copyright, use and
publish the same in print and/or electronically.
I agree that Alpha Kappa Alpha Sorority, Inc, Delta Rho Omega chapter, may use such
photographs of me with or without my name and for any lawful purposes, including for
example such purposes as publicity, illustration, advertising and web contents.
I have read and understand the above:
Signature ________________________________________________
Printed Name ____________________________________________
Address___________________________________________________
Date ______________________________________________________
Signature, parent or guardian ________________________________

Rites of Passage and Beautillion 2011-2012, Page 10 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

MEDICAL RELEASE FORM
PARENT/GUARDIAN INFORMATION
PARENT/GUARDIAN NAME: _________________________________________________
ADDRESS: ____________________________________________ APT# ________________
CITY: ___________________________________ STATE: ____________ ZIP: ___________
PHONE (HOME):________________________ (WORK/CELL): _____________________
EMERGENCY CONTACT PERSON: ___________________________________________
TELEPHONE: ____________________________ RELATIONSHIP:___________________
MEDICAL HISTORY
1. Are you presently under a physician's care? Yes____No____
2. Are regularly scheduled appointments required? Yes____No____ (If yes, please list the
condition(s) for which you are being treated. Use additional sheets if necessary)

3. List any medication(s) that you are currently taking and reason.
_____________________________________________________________________________
4. Have you had any contact with Hepatitis or other contagious illness? Yes____No____ (If yes,
list illness and dates)
______________________________________________________________________________
5. Have you had a PPD test? Yes____No____ (If yes, please give year) Year? _______ The PPD
test was: Positive____ Negative_____
If chest X-ray was completed: (Date) _________ (Result) _________________

Rites of Passage and Beautillion 2011-2012, Page 11 of 12

Alpha Kappa Alpha Sorority, Incorporated

Delta Rho Omega Chapter

Biennial Rites of Passage and Beautillion 2011-2012

6. Do you have or have you had any of the
Nervousness YES ____ NO ____
following during the past year? Persistent
Joint Pain YES ____ NO ____
Cough YES____ NO____
Back Pain YES ____ NO ____
Shortness of Breath YES____ NO____
Frequent Colds YES ____ NO ____
Chest Pain YES ____ NO ____
Palpitations YES ____ NO ____
Swollen Ankles YES ____ NO ____
Weight Loss YES ____ NO ____
Abdominal Pain YES ____ NO ____
Difficulty Voiding YES ____ NO ____
Hernia YES ___ NO ____
Frequent Vomiting YES ____ NO ____
Fainting YES ____ NO ____
Persistent Diarrhea YES ____ NO ____
Dizziness YES ____ NO ____
Constipation YES ____ NO ____
Numbness YES ____ NO____
Eye Problems YES ____ NO ____
Asthma YES ____ NO ____
Diabetes YES ____ NO ____
7. Do you have any allergies? Yes No (If yes, please list) Yes____No____
(If yes, please
list)______________________________________________________________________

I have read the completed "Medical History." The above medical record for my child is
thorough and accurate to the best of my knowledge.
Parent/Guardian's Signature:____________________________________ Date: __________
Please Print Name Here:_________________________________________

Rites of Passage and Beautillion 2011-2012, Page 12 of 12