Oklahoma Tornado Relief Service Trip Interest Survey

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First Name *

Last Name *

Phone Number *

Email Address *

Gender *

Female

Male

What is your affiliation with the UA campus? *

Faculty/Staff

Student

Alumni

Other:

Are you interested in traveling with the Community Service Center to serve in the disaster relief efforts in Oklahoma during the 2013-2012 academic year? *

Yes

What is the price you are willing to incur to make the trip? *

up to $100

up to $300

Not willing to pay

For which academic break would you be able to make the service trip? *

Choose any or all options that you would be interested in.

Fall Break

Thanksgiving Break

Winter Break

Spring Break

May Interim Break

Summer Break

Required

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