Participant Application for Alternative Break Trips

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

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* 1. Last Name

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* 2. First Name

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* 3. Nickname

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* 4. Permanent Address

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* 5. Phone #

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* 6. Birthdate

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

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* 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.

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* 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).

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

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