Fall 2015 Middlebury Alternative Break Participant Application
MAlt & Language in Motion Trip to Barre High School & Central Vermont Career Center (Barre, VT)
Application due date: Monday, October 5th
Submit applications to MAlt via email to middalt@middlebury.edu
Trip dates: October 23 - 25
Participant Fee: $30
*With additional support from the MAlt budget, the $30 fee covers all trip expenses including transportation,
lodging, food, and activity expenses associated with this trip.
Questions? Contact middalt@middlebury.edu
Name
Cell
Please indicate your age, year of graduation, gender, if you are an international student, and whether
you’ve been on a MAlt trip before (if so, specify which one).
Why are you interested in attending this trip?
What qualities, skills, and experience do you possess that would help you contribute to a successful
MAlt trip?
Please put an X next to the equipment that you own:
Sleeping Bag
Sleeping Pad
[Gear will be borrowed from the Mountain Club for participants who need any of these items]
Please indicate whether you have a 15-passenger van license (from Middlebury) and might be willing to
drive
____Yes
____No
____No, but I would be willing to get a license before October break
-Over -
Please carefully read all statements below, consider them seriously, and sign to indicate your agreement.
Commitment: If I am chosen to be a participant, by signing below I commit to attending one orientation MAlt
meeting leading up to October Break. I also commit to working with other trip participants, leaders, and advisors
to develop presentations and activities prior to the trip. I understand I have the option of participating in the fall
Language in Motion presenter trainings to support this process.
Alcohol/Drug-Free Policy: MAlt is an alcohol- and drug-free program. MAlt adheres to this strict policy in order
to achieve the program’s community service goals and to ensure the safety and well-being of all participants. As
such, students are not to possess and/or consume alcoholic beverages and/or illegal drugs while participating on
MAlt trips. Should this policy be violated, the participant will be asked to leave the trip and will be responsible
for arranging and funding his/her return travel. By signing below, I agree with this policy and will adhere to it
without exception.
Non-Refundable Payment Policy: All students accepted to a mini-MAlt trip must make a payment of $30 by the
date of our first meeting the week of October 12th. This payment will not be refunded. By signing below, I
signify that I understand the MAlt non-refundable payment policy. If the payment presents a significant financial
hardship, please contact Ashley Laux, Community Engagement (alaux@middlebury.edu) for information on
financial aid. (Electronic signature accepted)
Signature: ____________________________________________________
Date: ___________________
You will receive an e-mail by Thursday, October 8, as to whether you have been selected as a participant.