Participant Application for Alternative Break Trips

Please fill this out completely and submit. We will discuss next steps at the end of the application!

* 1. Last Name

* 2. First Name

* 3. Nickname

* 4. Permanent Address

* 5. Phone #

* 6. Birthdate

* 7. Email Address (you are expected to regularly check it)

* 8. Please list how you identify your gender (i.e., man, woman, trans*, etc.).
This may be helpful for us to know as we secure various lodging accommodations that may ask us to consider this information; if your site requires this, your site leader will open a conversation with your group and then create communication opportunities with individuals and the group before determining a plan. Our goal is always to secure lodging and host sites that offer inclusive facilities that welcome all.

* 9. If you require accommodations to be able to fully participate in this trip, please list them below so we can plan accordingly (if none, please list none).

* 10. Please confirm that you are applying for the correct trip by selecting the option below.