Bentley Alternative Winter Break Program

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Lasell College’s 2012

Alternative Spring Break Application

If you need additional space for any of these questions, please

type them up on a separate piece of paper and attach together

when you’re done!

Name: ______

E-mail______

Dorm Residence: ______Box #:______

Phone Numbers: School/Room: ______Cell:______

Home address: ______

______

Have you ever been on a Lasell College Alternative Break before?

Circle one: YES / NO

Do you speak another language other than English? ______

Age: ______Sex: M / F

Major: ______

Class: ’15 ’14 ’13 ’12

Please list activities and organizations with which you are presently involved: ______

Please describe any previous community service experiences that you have had either here at Lasell or in the past: ______

Why are you interested in participating in an Alternative Spring Break, and what do you hope to get out of this experience?
______

As a team member, what strengths and skills do you possess that you feel would be a contributing factor? ______

Describe how you would feel taking direction from a peer supervisor on this trip?

______

Lasell’s Alternative Spring Break Program is a long-term commitment. Participants are not only responsible for the trip itself, but also the fundraising and planning that goes into such a trip. You will be participating in team building meetings/activities/experiences both prior to and after our return. Do you have any questions or concerns? Are you willing to make the pre-time and post-time commitment required for this Alternative Spring Break?

______

It is not uncommon for participants to have some anxieties concerning their Alternative Break Trip, and also to wonder what challenges they may encounter. Please describe what you imagine to be your biggest challenge or concern while you are on this trip: ______

Some money will have to be raised by the students. Do you have any ideas for fundraising? If yes, please explain.

______

Alternative Breaks can be a lot of emotional and physical work. How do you deal when you are stressed out?

______

Do you have any physical limitations that we need to know about?

______

Are you van certified here at Lasell?
If you are not, would you be willing to become van certified for the trip?

______

Please list someone that we may contact as a reference: (a past or present professor, an organization leader, a work supervisor…) Please list their phone number.

Name: ______

Number: ______

Email: ______

*Please feel free to attach any other material you feel would be relevant to this process.

______

Print Name Signature

______

Date

Please return this to either Ginelle Gaulin-McKenzieor Amy Greene
in the Center for Community-Based Learning (Potter House lower level)

No later than 5pm on Tuesday, November 1