Winter Applications closed on October 7th. This application allows you to apply to be an alternate for Winter 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 Winter 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

December 2020

May 2021

Summer 2021

December 2021

Spring 2022

Summer 2022

Other

Will you be 21 years old before January 12th, 2019? *

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 & 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

Scheduling Conflicts *

I DO NOT have regular conflicts with the Alternative Breaks classes, which are held on Thursdays from 5:30-7:00 pm during the fall semester starting Oct. 18th.

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

(Selecting more organizations makes it easier for us to place you, though, of course, please only select organizations that you will be committed to engaging and actively volunteering with. You will have the opportunity to discuss your top organization choice below).

Focus: HOPE

Turpentine Creek Wildlife Refuge

Denver Rescue Mission

Hope House

Mission: Wolf

Bread for the City

A few of the sites may require volunteers to camp during their stay. Please indicate your level of comfort 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, communicate with housing and the non-profit, etc.). They must be available to attend mandatory Site Leader trainings (dates listed below) from 7:00-8:30pm. They pay only $245 for the trip instead of $270.

Yes

No

Are you available to attend the Site Leader Training on Thursday Oct. 18th, Thursday Oct. 25th & Thursday Nov. 29th from 7-8:30pm?

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