Name *
Name
Phone *
Phone
Address *
Address
Emergency Contact Name *
Emergency Contact Name
Emergency Contact Phone *
Emergency Contact Phone
School *
Year *
Expected Graduation Date *
If you will be 21 years old before May 16th, 2017, would you be willing to be a driver for your site? *
Drivers will be required to attend a mandatory driver training prior to the trip.
If selected as a driver for an Alternative Breaks trip, I understand that I will need to consent to a review of my driving record. *
T-shirt Size *
Do you consider yourself a non-traditional student? *
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.
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 winter, spring, summer, and fall break applicants. The existence of an applicant’s record does not necessarily preclude participation; however, it will be taken into consideration during the selection process.
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 *
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).
A few of the sites will require volunteers to camp during their stay. Please indicate your experience with outdoor camping. *
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 Thursday, March 16th from 7:30-8:30pm.
If you indicated that you are not interested in being a site leader, this question may be skipped.
If you indicated that you are not interested in being a site leader, this question may be skipped.
Are you available to attend a Site Leader Training on Thursday, March 16th?
If you indicated that you are not interested in being a site leader, this question may be skipped.

After you have submitted your application please sign up for an interview slot on Monday, March 6th or Wednesday, March 8th. 

You will receive an email with information regarding where to check in for your interview after the deadline for the application.
All interviews will be held in the Kansas Union.