Weekend Trip Application

Florida State Alternative Breaks

February 21-23, 2014

Trip Information

Dates:February 21-13, 2014

Agency: L’Arche Mobile

Social Issue:Persons with Disabilities

Location: Mobile, Alabama

Cost: $60 per participant

L’Arche is a group of communities where people with intellectual disabilities and those who help them can live, work, and share their lives together. Service tasks may include interacting with the members of the community, yardwork, building maintenance, and other assistance to the community. Students will stay onsite at L’Arche and will need to bring a sleeping bag and/or air mattress.

Florida State Alternative Breaks

Florida State Alternative Breaks facilitates service immersion experiences for students to serve with and in a diverse community, learn about social issues, and develop as leaders and active citizens.

Florida State Alternative Breaks is an Associate Member of Break Away, a national not-for-profit organization. As an Associate Member, it is our privilege to uphold the core philosophies of Break Away. These include the Eight Components of a Quality Alternative Break: Strong Direct Service, Orientation, Education, Training, Reflection, Reorientation, Diversity, and Alcohol and Other Drug Free.

Application and Selection

Applications are due by Tuesday, February 4 at 5:00pm. Applications must be brought to the Center for Leadership and Social Change in the Dunlap Student Success Center. Participants will be notified if they have been placed on the trip by Thursday, February 6. Trip payments can be made with check, money order, or cash. Students paying in cash should email Elaine Giles at to set up a time to make their payment.Checks should be made out to FSU Foundation with the subject line Alternative Breaks. Payments must be brought in to the Center for Leadership and Social Change by Monday, February 10 at 3:00pm to secure a spot on the Weekend Trip.

Important Dates

Applications Due: Tuesday, February 4by 5:00pm

Trip Payment Due:Monday, February 10 by 3:00pm

Required Pre-Trip Meeting: Thursday, February 13from 2:00pm – 4:00pm

Trip Departure: Friday, February 21 at 12:00 noon

Trip Return: Sunday, February 23 in the afternoon

Florida State Alternative Breaks Weekend Trip – L’Arche Mobile (February 21-23)

Applicant Information

Full Name:______Major: ______

Phone Number:______Email:______

Year in school: ______FSU ID:______

Date of Birth:______T-Shirt Size:______

Gender*: ______Ethnicity*:______

*Optional

There is a required pre-trip meeting that will be Thursday, February 13 from 2:00 p.m. – 4:00 p.m. Will you be able to attend the meeting? _____ Yes _____ No

Some FSAB trips needparticipants to drive university and rental vehicles to the trip destination. Are you willing to be a driver for your trip? _____ Yes _____ No

Have you been on an alternative break trip in the past?Yes_____ No______

If so, which trip(s)? ______

How did you hear about Florida State Alternative Breaks? ______

______

My signature below authorizes an official check of my university records to ensure that I am a student in good academic and disciplinary standing. It also certifies that I have read, understood, and agreed to the terms and conditions stated in the application and understand that FSAB is unable to issue refunds if I am unable to attend the trip for any reason.

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Print NameDate

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Signature