Alternative Break Application

Your Name

Your Class Standing

Your UNH Email

Your Spring Housing Assignment (if on campus, include building name and room number)

Briefly describe your prior community service experience:

What do you hope to get out of your experience with the alternative break program?

What prior knowledge do you have on homelessness and the issues that surround it?

Emergency Contact Name

Emergency Contact Relationship

Emergency Contact Phone Number

Commitment to Service

I understand that I will be committing myself to meaningful service work in my community over Spring Break. I agree to participate fully as an active member of the group, which includes orientation attendance, completing any necessary readings/watching videos prior to service, and all necessary preparations for the trip.

I understand that if I do not meet the group’s requirement for events or if my behavior becomes detrimental to the group, it may result in my termination as a member.

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