Project GIVE Alternative Breaks
Student-Volunteer Application
Spring 2015
Please return to the Civic Service Institute office located in SBS W room 6
Applications can be turned in during business hours.
Priority deadline for applications is December 12th at 4:00pm.
Please include a non-refundable $50 deposit with checks made payable to
“Project GIVE Alternative Breaks Club”
If you have any questions, please email
Personal Information
Name: ______NAU ID: ______
Age: ______
Major: ______Year: ______
Email: ______Phone: ______
Address: ______
T-Shirt Size: S M L XL
Dietary Needs/Allergies: ______
Are you willing to engage in a project that requires rigorous work? ______
Any special accommodations? ______
Trip Preference
Please rate your trip preference with 1 being your favorite and 3 being your least desired choice. Both the Southern Arizona and Grand Canyon trips are limited in size. There is a $50 non-refundable application fee that will go towards the overall fee of the trip.
· Flagstaff NAU Centennial Forest ______
Description: March 15-21, 2015. This trip will explore and serve in the areas surrounding Flagstaff with a focus on Environmental Stewardship, Ecological Restoration, and Environmental Sustainability. We will be camping in the NAU Centennial Forest and doing day trips throughout the week. Food, camping, and transportation are included. (There MAY BE a Day Trip Only option for students who cannot attend the whole week; please note if you would need that option.)
Cost: $100
· Southern Arizona border ______
Description: March 15-21, 2015. This trip will explore and serve in Southern Arizona along the border, primarily around Nogales. The gamut of border issues will be explored and will include tours and volunteer projects. A valid passport / I-20 Form is required for this trip.
Cost: $375
· Grand Canyon ______
Description: March 15-21, 2015. This trip will work closely with the National Park Service and the importance of volunteers to keep our national parks running and available for all. The work will most likely be focused on fire prevention and ecological restoration projects in the spring. Other projects may vary depending on the weather.
Cost: $200
Required pre-trip trainings will take place on in SBS West #6. Time (TBD)
Please include a days and times when you would be available for an hour long training.
Day:______
Time: ______
Personal Statements
1. Why are you interested in participating in Alternative Breaks? What do you hope to learn and gain from this experience?
______
2. Discuss your volunteer experience. Please include a specific example and what role you took in the project.
______
3. What are some personal qualities you have that are relevant to the first trip of your choice? How can you personally contribute to the success of this trip?
______
4. What are some fundraising ideas that you have?
______
5. Would you like to be considered for a leadership role? This involves attending weekly meetings, helping plan the trip, helping organizing fundraisers, gathering food, and taking on other important roles as part of the team.
If yes, please let us know what would make you a good leader and other leadership roles you have taken on.
______
Emergency Contact
Name:______
Relationship:______
Phone: ______
I have carefully read the above information and understand its contents. The above information provided by me is accurate.
Signature: ______
Today’s Date______
______
University Advancement Northern Arizona University (928) 523-2012
PO Box 4094 (928) 523-4445 fax
Flagstaff, AZ 86011-4094 www.nau.edu
PHOTOGRAPHY AND/OR TESTIMONIAL SUBJECT RELEASE FORM
Name ______
(please print)
I hereby grant permission for my photograph(s) and/or testimonial(s) in whole or in part to be used by Northern Arizona University as it sees fit with all rights for use assigned to them. I understand that I will not receive any compensation, now or in the future, for the use of said photograph(s) or quotes.
Date
Name______
E-mail Address
Address ______
Phone ______
For Students:
Year in School
Age
Major
Hometown
Signed ______
Date