Fall Applications closed on September 21st. This application allows you to apply to be an alternate for Fall Alternative Breaks. Applying here allows us to contact you if a spot becomes available on a break that you are interested in. *

Please indicate that you understand the significance of the Alternate Application.

I understand that applying here does not guarantee me a spot on a Fall Alternative Break and that I will be contacted if a spot on the break I want becomes available.

Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

School *

School of Architecture, Design, & Planning

School of the Arts

School of Business

School of Education

School of Engineering

School of Journalism & Mass Comm.

Dept. of Health Professions

School of Law

College of Liberal Arts and Sciences

School of Music

School of Pharmacy

School of Nursing

School of Social Welfare

Year *

Freshman

Sophomore

Junior

Senior

Graduate Student

Non-traditional student

Expected Graduation Date *

December 2018

May 2019

Summer 2019

December 2019

May 2020

Summer 2020

Fall 2020

Spring 2021

Summer 2021

December 2021

May 2022

Other

T-shirt Size *

S

M

L

XL

XXL

XXXL

University of Kansas Student *

I certify that I am a student at the University of Kansas enrolled in at least 6 credit hours with a GPA of 2.0 or above.

Yes

Zero-Tolerance Drug & Alcohol Policy & Liability Release *

I understand that Alternative Breaks has a zero-tolerance drug and alcohol policy while on any AB function. I also release AB from any claims/liability that might arise during any Alternative Breaks activity.

Yes

Will you be 21 years old by October 12, 2018? *

Yes

No

Scheduling Conflicts *

I DO NOT have regular conflicts with the Alternative Breaks classes, which are held on Thursday Sept. 28th, Thursday Oct. 5th and Thursday Oct. 12th from 5:30-7 pm leading up to fall break.

I DO have regular conflicts with the Alternative Breaks classes, and I understand that preference is given to students who are able to attend all classes.

Have you ever applied for a week long break before? *

Yes

No

Select any volunteer organizations with which you would be willing to participate. *

Selecting multiple organizations makes it easier for us to place participants on breaks. You will have the opportunity to discuss your top choice below.

HETRA

Palomar

Are you interested in being a Site Leader? *

Site Leaders take on additional responsibilities during the trip (e.g. tracking trip expenses, facilitating group dynamics, communicating with housing and the volunteer organization, etc.). They must be available to attend mandatory Site Leader training on Thursday, Sept. 27th and Thursday, Oct. 11th from 7:30-8:30pm. For their services, the cost of their Fall Break is $60, rather than $80.

Yes

No

Are you available to attend the Site Leader Training on Thursday, Sept. 27th and Thursday Oct. 11th?

If you indicated that you are not interested in being a site leader, this question may be skipped.

Yes

No

I permit Alternative Breaks at the University of Kansas to review my non-academic misconduct record through the Office of Student Conduct. *

Alternative Breaks reviews non-academic misconduct records for each of its Fall, Winter, Spring, and Summer Breaks. The existence of a record does not preclude an applicant from participation in Alternative Breaks, however, it will be taken into consideration during the selection process.

Yes