Pre-Registration Cincinnati Urban Experience
Use this form to begin the process of registering for an Alternative Break with the Greater Cincinnati Coalition for the Homeless. Once you submit the form, you will be contacted by the Director of Education by email for the link to the Registration Form. Planning will not begin until your non-refundable 25% deposit is received.
Name of person filling out form *
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Phone Number *
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Email *
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Organization Name *
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Program Name
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Mailing Address
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City
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State
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Zip Code *
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Arrival Date *
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Time
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Departure Date *
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Time
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Number of Participants *
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Participant Age Group *
Trip Options
Trip Theme (i.e. Homelessness, Hunger, Poverty, Gentrification, Displacement, Hope, etc.)
Your answer
Possible Educational Activities
Demographic Groups you are Interested in Interacting with during your trip
Is there anything else you like us to know to help us plan your trip?
Your answer
Next steps...
Once you submit the form, you will be contacted by the Director of Education by email with an initial invoice or questions regarding your registration. In the meantime, many answers that you may have can be found in the CUE info pdf: https://cincihomeless.files.wordpress.com/2012/08/cue_alternative_breaks.pdf

Planning for your trip will not begin until your non-refundable 25% deposit is received by the Homeless Coalition. You may pay by check and mail it to us at 113 E. 12th Street, Cincinnati, Ohio, 45202. If you choose to pay via PayPal, you must add an additional fee. Please contact the Director of Education to determine all costs before making a payment. Thank you!

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This form was created inside of Greater Cincinnati Homeless Coalition.