Class of 2012 Winter Retreat for Sophomore Students

Name:
Campus Address:
Campus Box #:
Campus Phone:
Cell Phone:
Email:
Class Year:
Racial/Ethnic Identity (optional):
Gender: Male Female
Major/Area of Interest?
Dietary Restrictions or Food Allergies:
Permanent Home Address:
City: State: Zip:
Country:
Permanent Home Phone:

Check all areas that you may be interested in investigating during your retreat experience (by checking you are not committing to these selections):

Spirituality
Health & Wellness
Friendships & Relationships
Time Management
Social options (on campus)
Career Exploration
Navigating Academics
Civic Engagement
Values, principles & ethics
Self Discipline
Intercultural Communication/understanding
Other, please describe

Why do you want to attend the Class of 2012 Winter Retreat for sophomore students? Check all that apply:

I want to meet more of my classmates.
I don’t want to stay home for the whole break.
I was encouraged to attend. By:
My friends are also applying.
I am looking for an opportunity to be involved.
I would like an opportunity to reflect.
Other, please explain

Trip participants will adhere to all policies and regulations set forth by Bucknell University in the Student Code of Conduct and the Bucknell Student Handbook. Success of this program for a participant is dependent on full and active participation for the entire retreat. 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.

By submitting this application, you agree that you have read the Class of 2012 Winter Retreat Expectations and Obligations (see above) and agree to all conditions relevant to the experience. If you are accepted to go on the trip, you will complete the required study in advance, take part fully in all aspects of the trip, and use the insight gained to the best of your ability.

Once your application has been submitted, please send your refundable reservation fee of $50 (cash or check) to: Office of the Dean of Students, 219 Langone Center. Fee will be refunded contingent upon participation in the program.