ST Fall Break Leader Application
Fall Break Leader Information
Fall Break: October 26-29
$25 dollar fee charged to student account: this will cover service trip expenses and t-shirt
*
1.
Name:
(Required.)
*
2.
ID Number:
(Required.)
*
3.
Email:
(Required.)
*
4.
Phone Number:
(Required.)
*
5.
Year in School:
(Required.)
1st year
2nd year
3rd year
4th year
*
6.
Age at time of trip?
(Required.)
18
19
20
21+
*
7.
T-Shirt Size:
(Required.)
Small
Medium
Large
X-Large
2X-Large
3X-Large
*
8.
Reference Name:
(Required.)
*
9.
Reference Phone Number:
(Required.)
*
10.
Reference Email:
(Required.)
*
11.
Do you have someone specific in mind as a co-leader? If so, who?
(Required.)
*
12.
What social issues are you interested in working with?
(Required.)
*
13.
Do you have an idea for a location for your service trip? (Must be under 6 hours)
(Required.)
*
14.
Why do you want to lead a service trip?
(Required.)
*
15.
What prior leadership experiences do you have that qualify you to lead a service trip?
(Required.)