Spring Break Service and Immersion Trip Application, March 2018
Please read the application carefully, and completely. Final Deadline to apply is Wednesday, December 6, 2017, at 11:59pm. Applications are not considered complete until a $150 deposit has been paid. Deposits may be paid by cash or check in the parish office, 8am-5pm Monday through Friday and are non-refundable. Full participation in the fundraiser, Tom's Event, including selling raffle tickets and attending two of your choice of three or more mandatory work dates, is REQUIRED to be considered for a trip.
Name as appears on ID or passport *
Your answer
Passport number if applying for international trip
Your answer
Local address *
Your answer
Permanent address *
Your answer
Cell phone number *
Your answer
Email *
Your answer
Birthdate mo/da/year *
Your answer
Parent's or legal guardian's names, contact numbers, and emails *
Your answer
Emergency contact if different from parents *
Your answer
Major(s) *
Your answer
Anticipated graduation date *
Your answer
Employer *
Your answer
Personal Reference, list name, phone, email *
Your answer
Work Reference, list name, phone, email *
Your answer
Choose Your Trip
Each trip is different in length and character and is designed to offer a unique immersion experience. Each has an element of service, but immersion in culture is the primary goal. Below the following descriptions, choose the three trips that most interest you.
1. Appalachia
Our Lady of Perpetual Help, Williamsburg, KY. March 9-18, 2018. Overnight on the way to and from in Central Illinois. Do local home repair projects, work at thrift store, experience life and culture of Appalachia. May include visit to Cumberland Falls for hiking. Estimated out of pocket cost per participant, $200.
2. Hurricane Relief
This 6 day, 5 night experience, will be in the Houston area. It will include transportation by motor coach from Ames to the mission site and back. All meals, lodging and materials will be included. Estimated out of pocket cost per participant will be $400.
3. Monastic Experience
Conception Abbey and Clyde Monastery, Conception/Clyde, MO. March 11-16, 2018. Visit men’s and women’s Benedictine communities to learn about Monastic life and ministries. This trip may not involve a great deal of service, but more of an immersion into monastic life and ministry; both contemplative and apostolic. Estimated out of pocket cost per participant, $150.
4. San Isidro, Nicaragua
San Isidro, Nicaragua. In partnership with EOS, International, March 9-19, 2018. This trip requires travel on the Thursday/Friday before and the Monday after spring break including driving to Chicago to catch flights. Immerse yourself in Nicaraguan culture including home stays, learning about alternative technologies that improve lives, and experience local parish life. May include weekend trips to an ecological reserve and a beach. Estimated out of pocket cost per participant, $700.
5. Washington, DC
Canceled
My top three trips, in order, are: *
Your answer
Short Answer Questions
Answers to questions should typically be more than one sentence, but no more than a full paragraph each.
1. Describe yourself in a creative way. *
Your answer
2. Why are you interested in the immersion experience for which you are applying? *
Your answer
3. Our hope is that you learn about and connect with people at your site, without judgment. How might we help you achieve this expectation? What expectations do you have for this experience? *
Your answer
4. What is your experience with service activities? Briefly describe the impact of one experience. *
Your answer
5. List one strength and one weakness that you bring to this experience. How would you capitalize on the strength and minimize the weakness? *
Your answer
6. What skills would you bring to this break experience? (e.g., carpentry, roofing, plumbing, prayer leading, cooking, languages) What is your level of skill? *
Your answer
7. Are you willing to facilitate an evening reflection during the trip? *
8. How would you respond if you were asked to share a bed, take cold bucket showers and/or use outdoor toilets. *
Your answer
9. Do you have any medical, dietary or other conditions that might affect your participation? Please explain. *
Your answer
Participant Responsibilities
1. Three organizational meetings before your trip, including some kind of service together. 2. Mandatory fundraising work dates (choose 2)
Tuesday, January 8th 6:00pm-8:00pm
Saturday, January 20th 9am-11am
Sunday, February 4th 11:45am-2:45pm
3. Fundraising dinner on January 27, 2018, 4-10pm.
4. Sell 20 raffle tickets for the 50/50 raffle. 50% of the proceeds of the raffle go to the winner, the other 50% to the event.
5. Preparation and presentation of post trip project with your trip team. Could be video, slideshow, or other creative idea.
Do you understand these responsibilities? *
Do you have any further questions or comments?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of St. Thomas Aquinas Catholic Church. Report Abuse - Terms of Service - Additional Terms