Cross-Cultural Community Service Fund Application The Cross-Cultural Community Service (CCCS) Fund is endowed by a Middlebury College Class of 1987 alumnus and supports international service-learning and community-building internships and/or related volunteer service opportunities for undergraduate students. These internships and service initiatives may be student designed; preference is given to those opportunities in a culture distinctly different from the applicant’s background. Funds are available throughout the academic year and for summer experiences. CCCS grants can cover travel and other expenses associated with an internship or service abroad. In addition, grants can be used to attend conferences or events (e.g., travel, registration fees, etc.) with an international theme in the U.S. While there is no maximum amount for which to apply, typical grants range from $250-$750; funds are limited and are intended to support as many student initiatives as possible. Therefore, it is important that you seek additional funding from other sources as appropriate; please note other sources requested, accordingly, including your own expected contributions (see Excel budget worksheet). If a group of students wishes to apply for a grant from this fund, all student names may be included on one application. These grants promote international civic engagement initiatives not otherwise fully funded by a department or student organization budget. Please complete the grant application below and worksheet at least 14 days prior to when funding is needed to support your project. Applications are typically reviewed on a weekly basis. If your request for funding is granted, you will receive a form that will instruct you regarding procedure for reimbursement and written evaluation. Please direct questions and/or submit the completed application to Community Engagement director, Tiffany Sargent, at [email protected] or stop by the 118 South Main St. office. J Term Internships! If you are seeking funding to support a for credit J Term internship, awards are typically $500 per student. (Apply for funding through Community Engagement, even if you are pursuing academic credit during J Term.) Pursue the credit option through CCI, the Center for Careers and Internships (link is to the CCI Winter Term Internship site). I. APPLICANT INFORMATION: Full Name: Class Year: Commons: Email: Country of Citizenship: Application Date: Cell Phone: Major (if declared): ID Number: Financial Aid Recipient? ___Yes ___No Box #: II. ACTIVITY / PROJECT INFORMATION: Desired Project /Activity: Proposed Date(s): Location: If for J Term Internship: Is this J Term proposal for credit? ___ Yes __No Apply for funding through Community Engagement, regardless If you checked “for credit:” of whether or not you are also seeking J Term credit. (New!) Transportation Method: If applicable Housing (hotel, etc.): If applicable Any Class Conflict(s)? “X” One __ No __Yes If yes, submit Absence Approval Form(s)1 III. SHORT ANSWERS: 1. Description: Add below a clearly worded and detailed description (one-page) of the activity or project and its greater significance to: (a) any activities in which you participate or have participated, and/or (b) your academic studies. 2. Community: Describe how do you plan to relate the knowledge or experience that you acquire through the program to our Middlebury community and/or with the greater local or global community in the future? Please note any specific programming or other ideas that you envision. 3. Budget: Complete and return the separate “CCCS Grant Itemized Budget” Excel worksheet. See “Sample CCCS Grant Budget” for help. Updated 11.03.14/TNS 1 Signed Absence Approval Form(s) must be submitted with this application if your proposed activity will result in absence from a scheduled class or other mandatory academic commitment.