Pre-Registration Cincinnati Urban Experience
Use this form to begin the process of registering for an Alternative Break with the Greater Cincinnati Homeless Coalition. 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.
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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
Your answer
Mailing Address
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City
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State
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Zip Code
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Your answer
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
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Choose
Youth (7th-8th)
Teen (9-12th)
College / University
Adult
Other
Trip Options
Soup Kitchen (meal prep and/or serving)
Food Pantry
Afterschool Programs
Cleaning / Organizing (various social service agencies)
Local Government
Museum / Arts
Shelter Service
Other:
Trip Theme (i.e. Homelessness, Hunger, Poverty, Gentrification, Displacement, Hope, etc.)
Your answer
Possible Educational Activities
Speaker's Bureau
Lunch on Food Stamps
Budget Activity / Minimum Wage / Wage Theft
Films
Social Justice Walking Tour
Park and Public Space Walking Tour
Streetvibes Shadow Activity
Solitary Confinement / Death Penalty
LGBTQIA+
Health and Human Services
Other:
Demographic Groups you are Interested in Interacting with during your trip
Children / Youth
Elderly
Veterans
Mental Health
Substance Abuse
Employment
Advocacy
Hate Crimes
Families with children
Prison
Affordable Housing
At-risk persons
Dietary Considerations
Your answer
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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