Name *
Name
Phone *
Phone
Address *
Address
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
School *
Year *
Expected Graduation Date *
T-shirt Size *
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.
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.
Scheduling Conflicts *
Have you ever applied for a week long break before? *
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.
Please note, your response below is an important part of your submission in this competitive application process.
Please note, your response below is an important part of your submission in this competitive application process.
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, September 29th from 7:30-8:30pm. For their services, the cost of their Fall Break is $60, rather than $80.
If you indicated that you are not interested in being a site leader, this question may be skipped.
Are you available to attend the Site Leader Training on Thursday, September 29th?
If you indicated that you are not interested in being a site leader, this question may be skipped.

You will receive an email regarding placements on Sunday, September 25th.