Alternative Spring Break 2019

Alternative Spring Break 2019

Participants are chosen based on an application and an interview process. Completing these forms does not guarantee that an applicant will be selected as a participant on this trip.

TRIP INFORMATION:
1. See, Act, Remember: Unidos Puerto Rico - Puerto Rico
-----THIS TRIP HAS BEEN FILLED-----

2.Volunteering: A Work of Heart - Memphis, TN

Spend the week partnering with local organizations dedicated to urban farming, homelessness reduction, and health education advocacy. Join us and learn how to become an active citizen with your home community.

-Dates of trip: 3/9 @5:00pm - 3/16 @TBD
-Dates of trainings & reorientation: TBD
-12-24 spots available
-$300.00
ALL PAYMENTS ARE NONREFUNDABLE

3. Cavin'n Carlsbad: Environmental Sustainability - Carlsbad, NM

In the “Cavin'n Carlsbad” trip we will be working with the National Park Service in New Mexico. Please see the details below for important dates regarding this trip:

-Dates of trip: 3/9 @5:00pm - 3/16 @TBD
-Dates of trainings & reorientation: TBD
-20 spots available
-$200.00
ALL PAYMENTS ARE NONREFUNDABLE
_____________________________________________________________________

If you are selected for an interview, you will receive an email with a link to sign up. Once the interview process is complete, you will be notified of which trip you have been placed on.

Failure to make any payments will result in the forfeiture of your spot, and an alternate will be given the option to attend in your place.

All payments (debit/credit card or check) are to be made at the Follett Student Leadership Center located on the main level of the University Center (Suite 180S). Payments are accepted on Monday/ Wednesday/Friday 10:00am-2:00pm.

THIS TRIP IS OPEN TO CURRENT UTA STUDENTS ONLY.

Student Information:
Name Name * First Last
Student ID# *
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Phone # Primary Phone # * - ### - ### ####
UT Arlington Student Email *
Date of Birth Date of Birth * / MM / DD YYYY
Classification *
T-shirt Size *
Any allergies, dietary restrictions, or other accommodations: *
Emergency Contact Information:
Name Name * First Last
Phone # Phone # * - ### - ### ####
Relationship *
See, Act, Remember: Unidos Puerto Rico - Puerto Rico
THIS TRIP HAS BEEN FILLED; DO NOT ANSWER
THIS TRIP HAS BEEN FILLED; DO NOT ANSWER
Volunteering: A Work of Heart - Memphis, TN
Please choose your preference for this trip: *
Interviews *
Conservating Carlsbad: Environmental Sustainability - Carlsbad, NM
Please choose your preference for this trip: *
Interviews *
Participant Questionnaire
1. Within the context of a "service trip" what does "service" mean to you? (1-3 sentences) *
2. AB strives to have a diverse group of majors on each experience. What is your major? How can you use your education to contribute to this immersive experience? (1-3 sentences) *
3. Each Alternative Break trip focuses on a particular social issue. Think of a social issue in which you are interested and describe your involvement (E.g homelessness, education, health, povery, mass incarceration). (1-4 sentences) *
4. What do you see your top strengths to be when working in a group? (1-3 sentences) *
5. If given the opportunity, would you be interested in fundraising to help raise funds for your trip? *

5. If given the opportunity, would you be interested in fundraising to help raise funds for your trip? Yes No
6. If given the opportunity, would you be interested in getting certified to drive a van for the trip? *

6. If given the opportunity, would you be interested in getting certified to drive a van for the trip? Yes No
7. How did you come to hear of Alternative Breaks? *

7. How did you come to hear of Alternative Breaks? Website MavOrgs Poster Information Table Other
Medical Insurance
Medical insurance is required to attend these AB trips. Do you have insurance, or will you need to purchase it for $5.00 per day ($40.00 total)? *

Medical insurance is required to attend these AB trips. Do you have insurance, or will you need to purchase it for $5.00 per day ($40.00 total)? I have medical insurance and will be able to provide policy information for my coverage. I will need to purchase insurance from UTA for the trip.
Agreement
Training is a vital component in educating participants on the community and social issue they will be working with. If you are selected for the trip there will be three training that you will be required to attend. *

Training is a vital component in educating participants on the community and social issue they will be working with. If you are selected for the trip there will be three training that you will be required to attend. I Agree
I would like to attend the Alternative Break trip and if I am selected, I agree to make the full payment. *

I would like to attend the Alternative Break trip and if I am selected, I agree to make the full payment. I Agree
Name Name * First Last