Office of Community Service-Learning - University of Maryland

Graduate Alternative Break Application

 

UID:
First Name:
Last Name:
Department:
Degree Sought:
Year in Program:
Email:
Phone:
Date of Birth:
T-shirt size:

XS S M
L XL XXL

   


Please list any activities or student organizations in which you are involved in:
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Do you have a valid driver’s license?
Yes No

Do you live on campus?
Yes No

Have you participated in an Alternative Break trip before?
Yes No         

Please describe your experience (i.e. where and when, details of the trip, etc.)

How did you learn about AB?

Do you speak a language other than English?

If yes, what language?

What level do you speak the language?

Please answer the following questions in the space below:
(your answers will be limited to the space below but you don't have to fill it up!)

  1. Why are you interested in participating in an Alternative Break trip?

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  2. What does service mean to you?  (i.e. what motivates you to be involved in community service)?

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  3. In thinking about your AB team, what are important qualities for your fellow group members to have?

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  4. If you could give one thing to every person in the world (not money), what would it be and why?

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  5. What are three words your friends would use to describe you?


What is your interest or expertise in the topic of rural healthcare, or of Western, NC?


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Please indicate ALL your availabile times to meet for an in-person interview on the following dates:

Monday, Nov 16th:
Tuesday, Nov 17th:
Wednesday, Nov 18th:
Thursday, Nov 19th:
Friday, Nov 20th: