Alternative Winter Break, 2016
Kanab, UT
Student Volunteer
Application
Service Focus: The trip will be to the Best Friends Animal Society in Kanab, Utah where students will care for
animals and learn about animal rights issues. Potential projects include socializing with animals, cleaning cages and
trail work.
Cost: $600 – This is all inclusive - ground travel, lodging, meals, and excursion activities. Food while traveling,
souvenirs, and optional activities are not included.
Additional grants are available and require a supplemental application, found attached to this application.
Dates: January 9th – 16th, 2016
Group Size: 12 student spaces are available. Spots will be awarded based on a review of this application. However,
if you are not accepted onto the trip, you will be put onto a waiting list. If someone drops his or her spot on the
trip, you may be pulled from the waitlist.
Transportation: All transportation will be included in the cost of the trip. We will be driving from California
Lutheran University to Kanab, Utah. We will be staying a night near Las Vegas to break up the trip.
For more information, please come to one of the interest/informational meetings - September 14th and 15th, 5 pm,
at the Chapel Lounge
Applications will be due on September 28th at 4pm to Nicole in Mod 2.
Applications will not be accepted electronically. PLEASE NOTE: The grant and STL applications are now a part of the general
student application, so all are due at the same time, together.
Students will be notified by CLU email about spot placement and grant qualification by October 2nd.
Instructions: Please fill out all sheets in this packet completely. A deposit of $100 is due with the application; please
attach your deposit (checks should be made out to California Lutheran University). Once a space on the trip is awarded
and accepted, your deposit will not be refunded. Incomplete applications will not be accepted. Spaces will be
awarded based on a review of this application and CLU status verification. Applications can be turned into Nicole in
Mod 2. Only CLU students who are currently enrolled may attend this trip.
Alternative Winter Break, 2016
Student Volunteer
Application
Kanab, UT
Volunteer Information: (Name provided must EXACTLY match the name on your passport. We will use this to reserve
your plane ticket.)
Name
CLU ID#
first
middle
last
Permanent address
City/State/Zip
Birthdate
Campus Box #
Email
Cell phone (

)
/
/
Home phone (
)
I have attended a CSC sponsored trip before.
Major ________________________________
Anticipated Graduation Year ____________________________
Emergency ContactTInformation
contactMedium
must be in aLarge
different household.)
Shirt Size: (each
Small
X-Large
2X-Large
Name
Cell phone (
Home phone (
)
)
Work phone (
)
Address
City/State/Zip
Eh
Email
Relation (friend, family, etc)
Name
Cell Phone (
Home phone (
)
Work phone (
)
)
Address
City/State/Zip
Email
Health Information
Relation (friend, family, etc)
Do you have any diet restrictions? (ex. allergies, vegetarian, etc)
Known Allergies
Please list any medications (incl. dosage)
Date of last Tetanus Shot
Are you Diabetic?
YES
(estimate is ok) Blood Type:
NO
Do you have a history of Seizures?
(optional)
YES
NO
Any medical conditions emergency personnel would need to know in the event of an emergency?
By signing below, I certify that the information provided on this form is true to the best of my knowledge and agree that a
California Lutheran University representative can release this information to Emergency Medical Personnel if I am involved in
an accident or am injured while on the Alternative Winter Break trip.
Signed: __________________________________________ Date: __________________________
Alternative Winter Break, 2016
Student Volunteer
Application
Kanab, UT
Code of Conduct Agreement
The Code of Conduct as stipulated in the Student Handbook applies to all parts of a study-travel
course. During travel, moreover, these five points are particularly important:
1. General Behavior
Students must respect the people and property as well as the local, state, and national laws.
2. Drugs
Possession and consumption of any illegal drugs at any time is strictly prohibited.
Faculty/administrators must be informed prior to departure of any prescription drugs, which must
be carried in their original containers.
3. Alcohol
Alcoholic beverages are prohibited on University-sponsored trips. Intoxication will not be tolerated
under any circumstances.
4. Attendance
Students are required to attend all scheduled activities of the group, beginning with pre-trip
meetings.
5. Dress Code
Students must dress in attire appropriate for the particular activities planned and appropriate for
the service work being performed, as determined by the administrative leaders. For this trip, dress
guidelines include:
A. For women: No spaghetti straps, no midriffs, no mini skirts, no mini shorts; no flip-flops,
sandals, or open-toed shoes at the service site.
B. For men: No hats in places of worship, no tank tops; no flip-flops, sandals, or other
open-toed shoes at the service site.
Violations of any part of the Code of Conduct may result in the student’s dismissal and being sent
back to CLU at his or her own expense. Further judicial action may be taken upon your return.
I understand and agree to the terms of this Code of Conduct.
Name (Please Print):
Student Signature:
Date:
Alternative Winter Break, 2016
Student Volunteer
Application
Kanab, UT
Short Answer Questions
Please answer the following questions separately on no more than two pages. Please do not include
your name on any of your answers. Simply attach them to the application.
1. Why are you applying for this trip?
2. How will this trip change or challenge you as a student? As a leader? As a member of
the global community?
3. We hope that those who attend this trip will be able to connect the service to their
future goals. How does this objective fit with your future?
4. What experience and or knowledge will you add to the group as we prepare for this
cross-cultural trip?
Application Agreement
By signing below, I:

Guarantee that all information provided in this packet is true to the best of my knowledge. I
understand that this information will be shared with members of the evaluation committee as
a part of the evaluation process.

Confirm that I am a CLU student currently enrolled in classes and give permission to the
Community Service Center to verify this information.

Confirm that I have read and understand the entire trip details sheet.

Commit to attending all of the Alternative Winter Break (trip and meetings) and understand
that once I am awarded a space on the trip, my deposit is non-refundable.

Understand that if I fail to attend the Alternative Winter Break trip that I will be responsible for
refunding California Lutheran University for any non-refundable costs incurred on my behalf.

Understand that if I am not initially accepted, I am not guaranteed a space on the Alternative
Winter Break trip and that my deposit will be returned to me if I am not assigned a space by
October 10th.

If applying for a grant, I agree that the Community Service Center may discuss my status with
the Financial Aid office to determine my need, and I agree to attend the pre-trip meetings and
share my experience with the CLU community through a presentation or approved project.
Name (Please Print):
Student Signature:
Date:
Application Checklist
__ Reviewed Trip information
__ Completed Volunteer & Emergency Info
__ Signed Emergency Medical Form
__ Reviewed & Signed Code of Conduct Agreement
__ Completed Short Answer Questions
__ Signed Application
__ Completed supplemental applications on the following page (optional)
__ Attached $100 deposit & understand that once a space is assigned it is NOT refundable
Alternative Winter Break, 2016
Kanab, UT
Student Volunteer
Application
Supplemental, Optional Applications
I am also applying for the following:
 Travel Grant
 Student Trip Leader position
Grant Application (to be completed only if applying for a grant)
Travel grants will be awarded to selected students. Grant recipients will be expected to
participate in all pre-trip meetings and will be asked to share their experience with the CLU
community through a presentation or other approved project.
Please check all of the following that apply:
 I have attended a CSC-sponsored trip before.
 I have received a grant for a CSC Alternative Break trip before.
 I am a first-generation student who either receives the Pell Grant or is qualified for
one.
Additional Short Answer Questions:
Please answer the following questions on a separate sheet of paper, separate from the first short
answer questions, in no more than 150 words each. Please do not include your name on any of your
answers. Simply attach them to the application, titled “Grant Application.”
1. How would not receiving this grant affect your ability to attend the trip?
2. What are your other plans for financing this trip – outside of this grant?
3. We are asking each grant recipient to share their experience with the CLU
community. How would you accomplish this task?
Student Trip Leader Application (to be completed only if applying for the STL
position – please see a copy of the job description on the following page)
Please answer the following on a separate sheet of paper, separate from all other short
answer questions, in no more than 150 words each. Please do not include your name on any
of your answers. Simply attach them to the application, titled “STL Application.”
1. This can be a significant time commitment and we are looking for a student who can
commit for the semester. Please include a discussion on how you plan to prioritize this
position within your schedule, and be sure to include all other commitments for the
semester leading up to the trip. Why are you interested in being a Student Trip
Leader? What do you hope to gain from this experience?
2. What previous leadership and/or civic engagement experience do you have that will
enable you to effectively lead a diverse group of students in deep discussions and
reflection?
3. How will being a Student Trip Leader benefit your growth and development as a
leader?
4. How would you work with a student who is disinterested or unwilling to participate in
the service projects and/or related reflection activities?
Alternative Winter Break, 2016
Kanab, UT
Student Volunteer
Application
Alternative Break Student Trip Leader Job Description
Thank you for your interest in being a Student Trip Leader for the Alternative Break
program. This position will be very rewarding, but can also take a significant amount of
time, so please carefully consider your availability and commitment.
California Lutheran University will offer an Alternative Winter Break Trip to Kanab,
UT this January 9th-16th, 2015. Two Student Trip Leaders, ten student participants, one
administrative advisor, and one faculty member will participate in the trip. The group will be
involved in assisting in animal shelter maintenance, socializing with animals, and other
service projects.
Student Trip Leaders will plan and lead the trip alongside the Coordinator for
Community Service, a campus pastor, and a CSC intern, who will provide support and
assistance. You and your co-leader will coordinate reflection activities and nighttime
activities if applicable as well as assist with on-site coordination as necessary. You may also
be requested to assist with other duties as assigned.
Required Skills







Positive attitude
Strong organizational, communication,
and interpersonal skills
Ability to manage many tasks
Passion for serving others
Leadership skills including consensus
building and group facilitation
Strong problem-solving skills
Must be in good academic standing
Preferred Skills



Experience in leading reflection groups
International travel experience
Group travel experience
Responsibilities:
 Work collaboratively and meet periodically with Staff and/or Faculty trip leaders and CSC
intern, as well as with student co-leader(s), and maintain regular and open communication
 In consultation with CSC staff, design and facilitate meaningful nightly reflection activities
 Plan & implement pre-trip meetings to prepare team for all aspects of travel; meetings will
include team bonding, cultural development, travel/safety guidelines, and
reflection/learning activities around issues to be addressed in the week of service
 Coordinate student fundraising efforts as necessary
 Other duties as assigned
Time Commitment:
 1-5 hours per week, depending on the week and work load/needs
o Should include meetings with co-leader(s) and Staff / Faculty trip leaders
Compensation:
 $50 towards the cost of the trip (cannot be used for your deposit); you are still eligible for a
trip grant.