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Alternative Spring Break
ASB Application
Application due: December 6, 2011
Participant Fee Money is due on January 17, 2012
First delegation meeting: January 22
, 2012 at 7pm
Please complete the following information. Note: This sheet will not be seen by the committee reviewing the application. It is only used regarding statistics and emergency situations.
Name:
Date of Birth:
mm/dd/yy
School Address:
Permanent Address:
Phone Number:
E-Mail:
Year/Class:
Sex:
T-Shirt Size:
Allergies:
Medical Problems:
In Case of Emergency, Contact:
Emergency Contact Phone Number:
Health Insurance Company:
Health Insurance Policy Number:
Answer Here:
Answer Here:
Answer Here:
Answer Here:
Answer Here:
What do you think the overall goals of Alternative Spring Break should be?
What qualities and/or skills do you possess that would help you in obtaining the goals of ASB?
A group of your close friends are planning a Spring Break to an exotic and far away island. They really want you to join them and ask you to explain why you want to participate in ASB instead. Give your response.
Briefly list and describe any volunteer work that you are currently doing or have done in the past.
Please rank in order which trip you would like to go on and give a brief explanation of why.
