Memphis Civil Rights Alternative Spring Break Trip 2012

• Name:
• Campus Address:
• Campus Box #:
• Campus Phone:
• Cell Phone:
• Email:
• Class Year:
• Racial/Ethnic Identity:
• Gender: Male Female
• Position/major/or area of interest?
• Permanent Home Address:
• City: State: Zip:
• Permanent Home Phone:

• Please indicate why you want to be a part of the Civil Rights Spring Break and what you feel you can contribute to the experience. Please add any comments you feel would be helpful.
• List five things that come to mind when you think about the U.S. Civil Rights movement.
• Keeping in mind that this trip involves a large group living communally, please describe your experiences working in groups and the roles you have played in group settings.
• How would people you know describe you? Use at least three (3) adjectives. (i.e. “fun, hardworking, kind, energetic, introverted, serious”, etc.)
• Given that air travel, performing community service, traveling in a large group, and learning about the civil rights movement can become stressful, please describe your typical reaction to stress.

• Work Skills
  Please list any relevant hobbies (such as photography or creating websites), work, or volunteer experiences you have that might be useful during this trip or for post-trip presentations. Describe what you did and the length of time you did it.
• Academic Experiences
  Please list any classes you have taken that you feel may be relevant to your experience working in a diverse community or helping with fundraising or publicity here.

Trip participants represent Bucknell University. As such, you will be held to high ethical expectations (i.e. upmost respect for the others on the trip and their beliefs, presenters, etc) when interacting with different constituencies, and during planned and unplanned activities. Group leaders reserve the right to require a participant to return to campus, at participant’s expense, if a participant’s behavior is deemed disruptive to the learning experience.

• In preparation for the trip, all participants are required to participate in an orientation program. This includes: educational session that will take place before the spring recess, one to two community service opportunities with local agency arranged by the Memphis leadership team, and pre-departure sessions to gain a historical perspective and to cover details about travel arrangements, packing, and trip logistics. Tentative Community Service dates will be throughout the month of February.

• Participants will be asked to participate in a post-travel interpretation of their experiences. In what ways do you think you’d feel comfortable sharing what you will have learned? (check all that apply)
• Talk with family and friends
  Talk with off-campus groups
  Present experience for students in class rooms or hall groups
  Share writings or photos from the trip
  Write press releases or speak on the radio about your experiences
  Other, please describe

• The trip is expected to cost between $600.00 and $700.00 per participant. This covers airfare, transportation to and from the airport, room, board, and transportation in Memphis. All participants are encouraged and expected to do fundraising to alleviate personal and program costs. Limited subsidies are available to help cover a portion of trip fees. Please indicate if you require financial help. Need for a subsidy will not impact the selection process.

• I will not need a subsidy
  I will need a subsidy of: $