Once you have completed your application and have your deposit ready:
1. Go to Student Engagement & Diversity (SU 316) M-F, between 8:00-5:00.
2. Give the following to the front desk staff:
a. Printed and completed application (this packet).
b. Travel Grant Application (optional- download Travel Grant Application from unlv.edu/service/ab).
c. Deposit as cash or check, see amounts below (or reduced/waived fee if you have had it approved after contacting ).
3. Receive your receipt and wait to hear from us! Check your email regularly.
Email or call (702) 895-5622 if you have questions in the meantime.
Basic Information:
First Name: / Last Name:
Cell Number: / Email (you are expected to check it regularly):
Address:
NSHE: / Birthdate: / Cumulative GPA: participants must be above 2.5 cumulative
Are you an undergraduate student or graduate student?
What trip(s) are you applying for? If you’re interested in specific trips only, leave other row(s) blank.
SPRING BREAK TRIPS
ð I would like to be considered for spring break trips, my preferences are listed below
1st Choice:
2nd Choice:
3rd Choice:
MAY TRIP
ð I would like to be considered for the May trip to Carson/Tahoe exploring Native American history/culture
DEPOSITS
ð I am applying to go on 1 trip (either Spring Break or May; I may have listed preferences for both Spring Break and May), and I will submit a $40 deposit
ð I am applying to go on 2 trips, and I will submit a $80 deposit
Are you willing to accept a spot on any trip? (circle one) / Yes / No
If you are not selected to go on a trip, would you like to be placed on a wait list? The wait list is for all trips. You may be contacted by phone or email up to 2 days prior to the trip; see our website for complete waitlist policy. You will need to attend a pre-trip meeting and complete your payment to go on the trip. / Yes / No
How did you learn about Alternative Breaks?
(faculty, elevator posters, RAVEs, TV screens, banners outside SU, friends, newsletter, social media, etc.)
Health & Safety Information:
Please fill out to the best of your knowledge. This information helps us know how to plan so the trip can account for the safety, health, and success of all participants. This info will be kept with Alt Break staff only.
Dietary (e.g. vegan, vegetarian, gluten free, lactose intolerant, food allergies, etc. If none, write none): / Known Allergies (If none, write none):
Medications, including dosage (we only use this info in case of emergency. If none, write none): / Accommodations requested (If none, write none. Ask us for more information if we can clarify):
On our trips, our goal is always to secure lodging and host sites that offer inclusive facilities that welcome and accommodate all participants. However, some of our sites are unfortunately not as flexible (i.e. sites offer shared sleeping space with all genders sharing common rooms; sites with binary gender restroom facilities). If you have specific needs or requests to make program staff aware of around lodging, we recommend communicating with our staff in advance so we can discuss logistics with you.
Would you like to have a conversation with a professional staff member from Alt Breaks to discuss housing questions or needs on a trip?
*If you mark yes, we need to be in touch before noon on March 14* / Yes / No
Please note: the San Diego Alternative Break Trip is visiting an area where there are frequently checkpoints set up by federal Immigration Customs and Enforcement officers on roadways. It is common that all vehicles are asked to pull aside; officers can ask for identification documents from all vehicle passengers. Students traveling on this trip should be aware of this as a likely situation, and decide for themselves if they are comfortable travelling on this trip.
If you have additional questions, please mark the box yes to have a conversation with a professional staff member from Alt Breaks.
*If you mark yes, we need to be in touch before noon on March 14* / Yes / No
*If you would like to reach out to program staff on your own, please feel free to do so at .
Learning Agreement:
The purpose of Alternative Breaks is to take groups of college students into communities outside of their own in order to engage in community service and experiential learning. Our commitment to you is that after attending Alternative Break you will:
1. Increase your knowledge of the issues addressed at AB and your knowledge of the health, cultural and social issues affecting the city you visit and the population you serve.
2. Reflect on the nature and purpose of service to others and service to the community.
3. Further develop your passion for serving others.
This is a commitment that Alternative Breaks makes to you. For you to get the most out of Alternative Break, you need to make a commitment as well to embrace the opportunities presented to you. Your commitment to this learning agreement will allow you and your fellow participants to have an educational and enjoyable trip.
Learning Agreement (cont.)
*All participants are expected to make this commitment. Alternative Break Trips will not allow behavior that is contradictory to this commitment or that impedes or distracts other participants from the experience. Read each statement carefully and initial on the line to the left to indicate that you agree.
1. _____ I agree to attend the complete program/schedule of Alternative Break trip as designated by the registration form or confirmation emails from my site leader and program staff. I understand that failure to attend parts or the whole of the Alternative Break trip without a valid and legitimate reason will result in me having to forfeit the full payment made to the program, and could involve an additional charge to my student account via the Bursar's Office for the alternative break program costs incurred by the University. Final discretion on a valid and legitimate reason will be determined by Stine Odegard, Program Coordinator for Service Programs and Sunny Gittens, Executive Director, Student Engagement & Diversity.
2. _____ I agree to attend all mandatory training and orientation/reorientation sessions (1 pre-trip meeting for weekends, 3 pre-trip meetings for week-long; attending and participating in the final reflection event). I understand that failure to attend these mandatory sessions without a valid and legitimate reason may result in my having to forfeit my spot on the Alternative Break trip and/or additional fees being assessed to my student account through the Bursar's office.
3. _____ I agree to fully participate in the program, and understand that participating means actively listening, sharing my viewpoint, and participating in activities. It also means that I will take responsibility for acquiring sufficient sleep and making additional choices so I am able to participate fully and respectfully.
4. _____ I agree to refrain from using alcohol or other drugs while at, or traveling to or from, Alternative Break. I will also challenge myself to confront the use of alcohol or drugs by other participants if I am aware of it. If I am aware of other participants using alcohol or drugs on the experience, I will communicate with Alternative Break staff. I understand that use of alcohol or drugs on my Alternative Break trip will result in my returning to Las Vegas at my own expense.
5. _____ I agree to be responsible for my own learning. I agree to ask questions if I do not understand and challenge myself to step out of my comfort zone for the week.
6. _____ I agree to respect individual differences and the dignity of all people. I will keep an open mind and strive to learn a new perspective of the world.
7. _____ I agree that if I violate the learning agreement, UNLV Policy, UNLV Code of Conduct, or local, state or federal laws while on the trip, I may be immediately sent back to Las Vegas at my expense with no potential refund of my trip fee, and in certain cases, additional charges may be applied to my student account through the Bursar's Office for travel fees incurred by the University while on the trip. Further action through Student Conduct may be taken upon return.
8. _____ Students must dress in attire appropriate for the particular activities planned and appropriate for the work being performed, as determined by the administrative leaders and the nonprofit hosts. Some of those guidelines may include wearing closed-toe shoes during any service experience, wearing sturdy clothing (long pants, thick material), avoiding potentially offensive logos/slogans/designs, and potentially dressing “modestly” (not exposing midriffs or undergarments, not wearing spaghetti straps or tank tops, etc.).We respect individuals' right to choose their attire and express themselves, but we also realize that we are guests of local educators and nonprofit partners while on an alternative break trip, and that these partners may have certain dress codes that help maintain a physically and emotionally safe environment for the clients and communities they work with. During pre-trip meetings, your site leaders will provide additional details specific to your site.
______
Alternative Break applicant/participant signature Print name of applicant/participant Date
By submitting your application, you agree to the following statements:
· I confirm that I am a UNLV student currently enrolled in classes at “full-time” status and give Student Engagement & Diversity permission to verify my enrollment, that my GPA is at or above 2.5 and that I am in good standing with the University.
· I commit to attending all of the Alt Break (AB) Trip(s) that I applied to be a part of and understand that once I am awarded a space on a trip, my deposit is non-refundable.
· I understand that all pre-trip meetings (3/23, 3/20, 4/6, 5-6:30 PM) and Java and Justice (Weds 4/26, 5-7 PM) are mandatory and that the only excused absence is for class; I am expected to rearrange any work schedules or other obligations to be able to attend these. If I have class during that time, I will submit a screenshot of MyUNLV demonstrating my enrollment in a class to .
· I understand that if I fail to attend the AB trip, I could be responsible for refunding UNLV for any nonrefundable costs incurred on my behalf.
· I understand that if I am placed on a waiting list, I am not guaranteed a place on the AB, and that my deposit will be returned to me if I am not assigned a space 5 days before the trip.
· If I applied to more than 1 concurrent trip, I am willing to participate in any of them, even if I am awarded a place on a trip that is not my first preference; if I am awarded a place on another trip I marked as a preference, but then decline that place, I can potentially forfeit my deposit.
Short Essay Questions
Please answer the following questions as comprehensively and creatively as you can. Your application will be scored by an Alternative Break Selection Committee based on your responses to these questions. Your name will not be given to the Selection Committee. Responses should be approximately 200 words.
Why are you interested in the trip(s) you applied for? Describe your passion or interest, your level of knowledge and/or experience with trip(s) you applied for. Be specific, use examples.(Keep in mind that experience with the issue is not a requirement to go on the trip- - a diverse group of people with varying knowledge often creates a great learning environment and most interesting group!)
What are you hoping to gain by going on an Alternative Break? Be specific, use examples.
What will you contribute to your Alternative Break Trip team and experience?