The University of Akron Civic Engagement Programs (serveakron) Alternative Spring Break Student Participant Application

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1 The University of Akron Civic Engagement Programs (serveakron) Alternative Spring Break Student Participant Application Thank you for expressing interest in The University of Akron s 2015 Alternative Spring Break! Please review this application packet carefully and thoroughly read the guidelines for participation.. If you have any questions, please us at serve@uakron.edu What is Alternative Spring Break (ASB)?: Alternative Spring Break trips will take place in a variety of communities and trips are designed to raise awareness of social issues and injustices through educational and volunteer focused opportunities. Alternative Break trips provide a variety of low cost, 4 or 5-day service experiences. Teams of students ranging from will be grouped together and assigned to a service opportunity that has been organized through Civic Engagement Programs. The 2015, the ASB trip cost is $300* per student - this price includes lodging, transportation, food, service projects, supplies, and recreational trips/experiences. What are the requirements to participate in ASB?: Participation on a Alternative Spring Break trip is open to enrolled students at The University of Akron. o Note: PSEOP and 60+ program students are not eligible to participate - contact serve@uakron.edu for more info. All students must be in Good Standing with the University - above a 2.0 GPA with no academic, disciplinary, or financial holds. All participants must pay the trip deposit by February 15 and be paid in full by March 1. o *See below schedule/explanation of payments for more information In order to participate in the Winder, GA trip, you must be an active member of a fraternity or sorority in good standing with the University. What are the advantages to attending an ASB trip?: ASB participants will be afforded the opportunity to give back to a community or agency in need. Students will interact with fellow UA students and together, will work to achieve the common goals and tasks of their assigned trip. You will experience a rewarding service opportunity that may take you out of your comfort zone, but we hope you will walk away from the trip with a renewed sense of UA pride and commitment to volunteerism. What will be expected of an ASB participant?: ASB participants will be expected to contribute to the goals and objectives stating by their Student Leader, Trip Advisors, and hosting agency/community. It is mandatory that you attend two ASB Participant Meetings prior to leaving campus. You will be required to uphold all University policies and guidelines. And among others, you will need to communicate effectively with your assigned Student Leader, Trip Advisors, and fellow ASB participants. Interested in serving as a Student Leader?: Student Leaders will serve as liaisons, decision makers, and assistants for the planning and duration of the ASB trip. This position will provide you with a valuable leadership experience and this position will be essential in order for our trips to be beneficial and impactful for all of our participants. Student Leaders will be exactly what their title reflects.leaders! If interested and selected, you will be expected to contribute to the planning and facilitation of the trip. You will need to attend both Student Leader and ASB Participant Meetings and Training Sessions. All applications and deposits are due by 5pm on Friday, February 6, 2015 FSL - GA 1 P a g e

2 Trip Duration: Trip duration and departure/arrival times vary based on location and time needed for travel. A typical work day for all trips is the following: 6:30am Wake-up 7:00am Breakfast 7:45am Leave for worksite 8:30am Arrive at worksite 8:30-11:30am Volunteering 11:30-12:30pm 12:30-5pm 5:00pm 5:30pm 6:30-7:30pm Break for lunch at worksite Volunteering Leave worksite Arrive back to lodging facility Dinner & Evening Activities The above is a typical schedule and may be subject to change based on volunteer assignments and agency needs Recreational/Education Activities: Each trip has been allotted recreational/sightseeing time and all trip activities will be coordinated by the Trip Advisors and Student Leaders for each location. Possible activities include; bowling, sightseeing tours, and local attractions. Facilities: Volunteers are typically housed at local camp grounds, hostels, or churches. All accommodations will include shower facilities, dining/kitchen areas, and recreation areas. Participants must stay in housing provided. Meals: All meals (breakfast, lunch, and dinner) are most frequently coordinated and prepared by trip participants and Trip Advisors - some meals are provided by host sites. Most lunch items will be provided for you to pack for yourself each day. Should you have any food allergies or preferences, please explain on page 4. Valuables: Please limit the valuables you bring with you. Do not bring something that you would be sad to lose, see get dirty, or have broken. Staffing: All Alternative Spring Break trips are coordinated by the Department of Student Life and University of Akron staff. Full-time UA staff members accompany volunteers for the entire trip. Service projects are planned and supervised by the staff of the respective agency being served during the week. Recreational activities are preplanned by University staff and are approved by the Department of Student Life. Transportation: Transportation to all project locations and to/from UA is provided by The University of Akron. Participants who find, for any reason, that they must return home or any other destination prior to the end of the trip must provide transportation at their own expense and must be approved in advance of leaving the trip. While traveling, students must use the shuttles provided by UA - all vehicles and drivers are provided by pre-qualified vendors. What to Pack: A sample What to Pack list is included in this packet. This should give you a start on how to prepare for the trip. Please remember to pack as lightly as possible storage is limited both within vehicles and at housing locations. Trip Cost: For 2015, the ASB trip is $300 this includes a $75.00 non-refundable application fee and a one-time (scheduled) payment of $225 prior to the trip. All payments are coordinated through the Information Center, located on the first floor of the Student Union. Additional Details & Questions: Please contact Alison Doehring, Assistant Director, Student Life, at or serve@uakron.edu FSL - GA 2 P a g e

3 What to Pack: Suggested List Based on your assigned trip, you may be given a revised or more detailed packing list. Sleeping bag and/or bedding items Pillow Personal hygiene items and toiletries Sunscreen Insect repellant Prescription medicines Towels & washcloths State ID/license Student ID (Zipcard) Flashlight & batteries Long, sturdy pants (suggested: jeans) Long sleeved shirts T-shirt(s) Sturdy boots/shoes Hat or bandana Shorts Tennis shoes Sweatpants Undergarments Pajamas Fleece/light jacket Sunglasses Water bottle Day bag, tote bag, or bookbag Cell phone Any needed charging cords Schedule of Payments All applications and deposits are due by 5pm on Friday, February 6, 2015 o Please note: participation/placement is on a first come, first serve basis All Alternative Spring Break participants are required to pay a non-refundable $75.00 deposit o This payment is due to the Information Center, located on the first floor of the Student Union o All application deposits are due with your completed application o Payment options: cash, check, MasterCard, VISA, and Discover Higher preference priority will be given to those participants that pay in full by Sunday, March 1, Once your application fee has been paid, you will receive updated information about additional payment: o Remaining $225 payment is due by Sunday, March 1, 2015 o Cancellations after Monday, March 2, 2015 will not be eligible for payment reimbursement Schedule of Group Meetings In order to ensure all groups have a chance to meet before leaving for ASB, student participants are asked to attend two meetings the weeks leading up to spring break. These meetings will review the following: o Overview of policies and expectations for the trips o Get-to-know-you activities for participants o Discussion of service projects, agency, and scope of work o Review of what to pack and trip logistics Below are the tentative dates for 2015 meetings/events - once your application is received you will be added to our list-serv to receive s and reminders: o Wednesday, March 4 - ASB Mixer/Social in the Game Room - 5pm o ASB Group Meeting #1 - Monday, March 9 or Tuesday, March 10-6pm - SU Ballroom C,D,E o ASB Group Meeting #2 - Monday, March 16 or Tuesday, March 17-6pm - SU Ballroom C,D,E o National Volunteer Week: ASB Display - Monday, Mach 13-3pm - SU Trapezoid Lounge o National Volunteer Week: ASB Reception/Reunion - Tuesday, March 14-7pm - SU Ballroom C,D,E **Please keep pages 1-3 for your records* 3 P a g e

4 Applicant Information: Please complete all information fields included within this packet Name: First Middle Last zips.uakron.edu Student ID: Gender: M or F Shirt Size: Small Medium Large X-Large XX-Large XXX-Large Primary Address: Street City State Zip Code Cell Phone: ( ) - Birth date: Month Date Year Major: Chapter: Anticipated Graduation Year: Initiation Semester/Year: Do you have any food allergies or preferences? Yes No If yes, please explain: List any medications you may need to bring with you: Have you had a tetanus shot within the last 7 years? Yes No Have you participated in UA s ASB program before - or any other service/mission trips? If yes, please provide details: Are you interested in serving as a Student Leader for a trip? Yes No Unsure If there is an ASB attendee that you d prefer to be placed with, please provide his/her name: 4 P a g e

5 Health Insurance: Do you carry medical insurance? Yes No If yes, please provide the following Provider: Policy Number: Phone: Emergency Contact Information: Name: First Middle Last Relationship: Primary Address: Street City State Zip Code Cell Phone: ( ) - Work Phone: ( ) - Guidelines and Policies: This trip is meant to provide an educational and hands-on experience for all participants. In order to uphold the integrity and mission of the trip, the following guidelines are in place. Please carefully read and initial next to each of the following indicating that you have read and understand these policies As a participant, I must utilize University provided transportation at all times. As a participant, I must utilize University provided housing while on my designated trip. I understand that no participants are permitted to consume alcohol or drugs at any time on an ASB trip regardless of age or laws in the host site area. The policy is zero-tolerance meaning violations will be addresses and will be subject to disciplinary action. I will not be allowed to venture around a city or area without the group or my assigned Trip Advisors and Student Leader(s). I understand that the Trip Advisors assigned to my trip are authorized University officials and I will be held accountable for my actions while traveling on behalf of the institution. I understand that if I am found to be non-compliant, or if I break any of the guidelines and policies of Alternative Spring Break, I will be referred to the Department of Student Conduct & Community Standards upon my return to campus. 5 P a g e

6 Interest Questions: In order to help us plan the most impactful and meaningful trip experience for our students, we first need to know why you are interested in participating, what you hope to gain from this experience, and why you have chosen to dedicate your time to serving others! Please attach your resume and your thoughtful response to these questions. Note: responses do not need to be lengthy, but more informational about yourself. Why are you interested in the Alternative Spring Break program?: What do you hope to gain or learn from participating in an ASB trip? What do you consider to be your greatest strength and what is one area of growth? Describe yourself in three words. How do you believe participating in this trip will help you be a better member of the fraternity and sorority life community? If you would be interested in serving as a Student Leader position, please include: What motivated you to apply to be a Student Leader on an ASB trip? What do you hope to gain from this leadership experience? What do you feel you can contribute as a Student Leader? How did you find out about ASB?: Through Zipmail Former ASB participant Through a friend/chapter member Through the ASB website Through a poster/flyer on campus Other: 2015 Trip Option: *serveakron is hosting three additional ASB trips, for information on these please see Where Young Spirits Soar Location: Winder, GA Capacity: 45 volunteers Agency and Scope of Work: Please note: This trip has been planned exclusively for members of fraternity/sorority life Camp Twin Lakes o Maintenance/repair projects, brush/limb removal, painting, cleaning etc. Trip Duration Saturday, March 21-Friday, March 27 Work days: Monday-Thursday Travel Days: Saturday (leaving: pm) & Friday (home by: pm) About this Site For the past 21 years, Camp Twin Lakes has provided life-changing camp experiences to thousands of Georgia's children with serious illnesses, disabilities, and other life challenges. Camp Twin Lakes provides week-long summer camps and year-round weekend retreats at three fully-accessible and medicallysupportive campsites, day-camps, and through hospital-based Camp-To-Go programs. - facebook.com/camptwinlakes 6 P a g e

7 THE UNIVERSITY OF AKRON INFORMED CONSENT, RELEASE OF ALL CLAIMS AND MEDICAL AUTHORIZATION I, (print name) acknowledge that I voluntarily desire to participate in an Alternate Spring Break Trip, participation in which is offered to students and professionals at The University of Akron. I understand that this trip is not a required component of any course. I acknowledge and understand that my participation in this event will begin on March 21, 2015 and conclude on March 27, I further understand that my participation in this event may expose me to certain risks and personal injuries, including death, as well as damage or destruction to my personal property. In consideration of being permitted to participate in this trip, I hereby declare and agree as follows: I declare that I have no physical, mental, or emotional condition, limitation, or disability that would preclude me from participating in this event. I understand and agree that the University personnel accompanying University students in connection with this trip retain the final discretion over the activities associated with this event when it is reasonably determined by such personnel that my safety or the safety of others will be adversely affected. I further understand that while on this trip I am required to abide by the University s Student Code of Conduct, as well as the trip s prohibition against use of alcohol and illegal drugs, and that if I fail to do so, it may negatively affect my ability and authorization to participate in this event and may subject me to discipline for violations of the Code of Conduct. I voluntarily assume any and all risk of accident or personal injury or damage or loss to my person or property and hereby release The University of Akron, its Board of Trustees, officers, employees, agents, representatives, or volunteers from every claim, liability, or demand of any kind sustained, including, but not limited to, any injury, sickness, death, loss of money or personal property, legal entanglement, or any other claim, whether or not caused by The University of Akron or its officers, employees, agents, representatives, or volunteers in connection with this trip. I hereby consent to the reasonable discretion of the personnel accompanying University students in connection with this trip, and I understand that such personnel are not medically trained to care for any physical or medical problems that may arise nor or they trained in the activities in which I may participate. Therefore, I authorize the administration of emergency first aid care and treatment, the administration of any treatment deemed necessary by a licensed physician or dentist, and the transfer to any hospital, clinic, or other facility reasonably accessible. I understand that should any such medical care or treatment be necessary, I am fully responsible for all costs associated with such care and treatment. I agree to hold The University of Akron, as well as its Board of Trustees, officers, employees, agents, representatives, or volunteers harmless. I agree that this release binds any of my heirs, administrators, executors, and/or assignees. I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE BEFORE HAVING SIGNED THIS DOCUMENT. Print Name Signature Date 7 P a g e

8 THE UNIVERSITY OF AKRON ALCOHOL AND DRUG-FREE AGREEMENT I, (print name), wish to participate in the Alternative Spring Break trip from March 21, 2015 to March 27, It is my full understanding that I will not possess or use alcohol or any controlled substances while on the Alternative Spring Break trip. I understand that any use or possession of alcohol and/or illegal substances as well any misconduct may result in my dismissal from the program and referral to the Department of Student Conduct & Community Standards. I also understand that, if at any time, I am found to be using alcohol and/or illegal substances that I will be dismissed from continuing to participate in the service trip and sent home at my own expense. By signing below, I acknowledge that I have read and understand this agreement and agree to abide by it. Print Name Signature Date THE UNIVERSITY OF AKRON PHOTO/VIDEO RELEASE FORM I authorize The University of Akron to record my/my child s name, voice, likeness and biographic information on videotapes, audiotapes, photographs, CDs, DVDs, video clips and/or web-based materials (media) at The University of Akron s discretion. In addition, I give The University of Akron permission to view, use, and edit such media. I waive all rights to inspect and/or approve the media and any copy that The University of Akron may use in conjunction with the media and the uses to which they may be applied. I understand that The University of Akron may use the media, in whole, in part, or in composite for educational, research, or promotional purposes, or for any other uses The University of Akron deems fit. I understand that The University of Akron owns all rights to the aforementioned media. I waive all rights in the media and release The University of Akron from any loss, damage, and/or liability arising out of my appearance on such media. Print Name Signature Date 8 P a g e