Name: ___________________________________________________________ Box #: ______________
Student ID#: ____________________________ Phone #: __________________________________
Mentor: _______________________________ Major: ___________________________________
Email: _________________________@eckerd.edu Birthdate: _________________________________
Year (please circle one): Freshman Sophomore Junior Senior PEL
Check here if you are interested in applying for a need-based scholarship: _____
Check here if you are a freshman, sophomore, or junior and interested in earning Co-Curricular Reflective
Service-Learning hours: ______
I am primarily interested in the following trip (Circle one):
1. Revitalizing the Health and Future of Children:
Nicaragua | Faculty Leader: Adam Guerin
Student Leader: Derek Bedami
2. The Tabooed Epidemic: HIV/ Aids in Modern America:
St. Petersburg | Staff Leader: Hayley Musial
Student Leader: Henry Ashworth
3. Spiritual Environmentalism:
Puerto Rico | Faculty Leader: Amy Langenberg
Student Leader: Clara Suarez-Nugent
4. Education in the Blue Mountains:
Jamaica | Staff Leader: Andrea Castaneda
5. Appalachia Service Project: Warmer, Safer, & Drier
Kentucky | Staff Leader: Saige Liparulo
Student Leader: Haley Burger
6. Enrichment in Ecuador: Gain Perspective and Experience
While Helping Groups in Need
Ecuador | Faculty Leader: Crystal Young-Erdos
Student Leader: Alexander Walt
7. Holistic and Sustainable Living:
Costa Rica | Faculty Leader: Doug McMahon
Student Leader: Andréa Martin
8. A Yogi’s Journey Through the Local Environment
St. Petersburg | Faculty Leader: Ronald Porter
AmeriCorps Leader: Jenna Behnke
9. Faith, Hope, and Service:
Cuba | Staff Leader: Andrew Black
Student Leader: Zoe Gipson-Kendrick
10. Helping Hands: Assisting at an Orphanage:
Panama | Staff Leader: Grant Bailey
Staff Leader: Tonya Womack

**If space is full for the trip you selected above, do you want to be automatically registered for a 2 nd
or 3 rd
(or more) choice? By circling no your application is void if you are not selected for your primary trip. Please circle:
YES NO
If yes, what other service trips, in order of preference, would you like to register for?
(Your non-refundable deposit will automatically go to one of your alternative choices if you are selected for a trip)
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Please respond to the following questions on a separate piece of paper:
1.
Have you participated in past EC fall or spring break service trips? If yes, which one(s)?
2.
Have you previously applied for an EC fall or spring break service trip but were not accepted to any? If yes, which one(s) and when?
3.
What volunteer/service work have you participated in during your time in high school and at Eckerd College?
4.
Do you speak any languages other than English? If yes, which ones and describe your level of competency.
5.
Why are you particularly interested in the spring break service project that you have selected?
6.
If selected, what skills and experiences will you bring to your spring break service project group?
Please respond to the following essay questions on a separate piece of paper (1 page double space maximum for each essay)
1.
How do you think this project will enhance your current academic, personal, and career goals?
2.
What is poverty? Do you think it is an issue of concern in our current global society? Are there any
intersections between poverty and the focus topic of your anticipated spring break service project?
Please submit your registration and receipt for your deposit no later than 5:00 PM on December 2, 2015. If you are applying to an international service project, you must include a copy of your passport or a receipt of passport application.
Deposits can be paid in cash, check, or by credit card at the Cashier’s Window or Bursar’s Office, in Franklin
Templeton.
Yes, I would like to participate in Spring Break Service 2015. I understand that as a participant, I commit to attending all activities organized by the group leader for the full duration, including orientation sessions prior to Spring Break. I understand that the prices for Spring Break Service Projects are subject to change. I understand that if I am selected for a trip my deposit is non refundable. I also understand that all Spring Break Service experiences are alcohol and drug free.
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Signature Date