2020 Spring Break Immersion Program Application
Welcome to the Spring Break Immersion Program!

Please note that your payment can be made one of three ways:
1) Drop a check made out to College of the Holy Cross or cash off to the Bursars' Office (O'Kane 159). It is preferred that you use the yellow "Immersion" envelopes available in Campion House. Otherwise, you must mark clearly that the payment is for immersion, or it will instead be defaulted to your tuition.
2) Mail a check to the Bursars' Office (clearly mark that the payment is for immersion).
3) Pay online at https://holycross.afford.com/. Be sure to select the Immersion Gateway rather than the Tuition Gateway, and use your account number when making the payment rather than your debit card number.

Participation release forms will be emailed to you upon receipt of your application.

If you have any questions, please reach out to us at springbreak@g.holycross.edu. We can't wait for you to immerse yourself through this special program!
Email address *
First Name *
Middle Name *
Last Name *
Student ID # *
Date of Birth (month/day/year) *
Mobile Phone *
Email *
Please write out your entire email address (i.e. include @g.holycross.edu).
P.O. Box # *
Primary emergency contact information *
Please include the name and two phone numbers for your primary emergency contact in the following format: Full name, relation to you (e.g. parent), (XXX)-XXX-XXXX, (XXX)-XXX-XXXX
Secondary emergency contact information *
Please include the name and two phone numbers for your secondary emergency contact in the following format: Full name, relation to you (e.g. parent), (XXX)-XXX-XXXX, (XXX)-XXX-XXXX
Gender *
Class Year *
T-Shirt Size *
Which sites are you interested in? *
L'Arche communities provide homes and workplaces where adults with and without developmental disabilities live with one another. Please find out more information about L'Arche here: https://www.larcheusa.org/. Louisville, Camden, St. Louis, New Orleans, and Chicago all offer urban immersion experiences, while in Alamosa you'll be spending your time working at La Puente Home, a shelter that serves those experiencing homelessness. Our sites in the Appalachian region offer rural immersion experiences. NOTE: All participants will be included in the Appa pool. If you are interested in any of the other sites, please indicate by checking the coordinating box. If you are only interested in going to Appa, please select the last option. If you are interested in sites with different deposit amounts, please pay the greater deposit. Deposits are nonrefundable.
Required
Please list all other potential SBIP participants that you know well. *
Please list any sites that you have previously been to through Holy Cross' immersion programs. Be sure to include the year that you went there. *
Be specific (i.e. Ivanhoe in 2019, L'Arche, NY in 2018, Alamosa, CO in 2017.)
Optional comments:
Please feel free to make any comments that would be helpful to us as we decide your placement (e.g. particular interests or skills, physical limitations, health issues, previous experiences, etc.).
Do you wish to apply for financial aid? *
The SBIP needs participants that are willing/able to serve as drivers on their trips. Drivers must be 21 years of age or older. Will you be 21 years old by February 28, 2020?
Please note that van drivers receive a $50 discount in price, but this does not apply if you will receive financial aid toward your trip.
Clear selection
If so, are you willing to drive a mini-van during your immersion trip?
Clear selection
Have you received van-certification at Holy Cross?
Please note that van certification courses will be offered after sites are revealed; you will have the opportunity to get certified then if you would like to drive and are not yet certified.
Clear selection
By checking this box, I agree to complete and deliver my SBIP 2020 release forms to Campion House by November 1, 2019. I also agree to submit my deposit by November 1, 2019. *
Required
Thank you for completing your application!
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