Summer Applications closed on March 20. This application allows you to apply to be an alternate for Summer 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 Summer 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/Nursing

School of Social Welfare

Year *

Freshman

Sophomore

Junior

Senior

Graduate student

Non-traditional student

Expected Graduation Date *

May 2019

December 2019

May 2020

Summer 2020

December 2020

May 2021

Summer 2021

December 2021

May 2022

Summer 2022

December 2022

May 2023

Summer 2023

December 2023

May 2024

Other

Will you will be 21 years old before May 20th, 2019 and would you be willing to serve as a driver for your group? *

More information about driving will be available at interviews and in our class meetings.

Yes

No

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 *

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

If you included any accommodation requests, please mark "I agree" to acknowledge that you will actively participate with the Alternative Breaks leadership to plan and complete an agreement for reasonable accommodations.

If you did not include accommodation information, you may skip this question

I agree

Scheduling Conflicts *

Participation in Alternative Breaks requires the attendance of six class meetings on Thursdays from 5:30-7:00pm beginning March 21, 2019. Though class conflicts do not disqualify you from participating, they will be taken into consideration regarding Break placement.

I DO NOT have regular conflicts with the Alternative Breaks classes, which are held on Thursdays from 5:30-7:00 pm starting March 21, 2019.

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

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

Yes

No

Select any sites in which you would be willing to participate. *

(Selecting more sites makes it easier for us to place you, though of course please don't select a site that you would not be 100% willing to volunteer with).

Palomar; Oklahoma City, OK

Capstone Adaptive Learning & Therapy; Pensacola, FL

Inside/Out Youth Services; Colorado Springs, CO

Mission: Wolf; Westcliffe, CO

It is possible that certain sites will require volunteers to camp during their stay. Please indicate your experience with outdoor camping. *

Please don't make me camp

I don't want to camp but will if necessary.

I am comfortable with the idea of camping outside.

I love to camp and/or have extensive camping knowledge.

Are you interested in being a site leader? *

Site Leaders take on additional responsibilities during the trip (e.g. tracking trip expenses, maintaining positive group dynamics, communicating with housing and the non-profit, educating group members on your site's respective issue area, etc.). They must be available to attend mandatory Site Leader training on Thursdays, March 21th, April 4th, May 2nd from 7:30-8:30pm. Site leaders receive a discount in their program fee, so they pay $270 instead of the full price of $295.

Yes

No

Are you available to attend a Site Leader Training on Thursday, March 21st, Thursday, April 4th & Thursday, May 2nd?

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