2025 COC Summer Leadership Application

This commitment form is for those who have been accepted to serve as a leader on a 2025 Summer Project hosted by CO Charlotte and/or CO Charleston. The commitment deadline is Friday, December 6, 2024. If you have any questions, please contact your campus staff person, or email charlotte@campusoutreach.org (for CO Charlotte students) or charleston@campusoutreach.org (for CO Charleston students). Thank you!

Name*

First NameLast Name

Gender*

FemaleMale

E-mail*

Cell*

Region*

CharlestonCharlotte

School*

To which summer opportunities are you committing (check ALL that apply)?*

Alpha ProjectAlpha "E" Project (Elon students)CO Charlotte Cross-Cultural Project (South Africa)CO Charleston Cross-Cultural Project

Do you anticipate having a car while at Alpha?*

YesNoNot sure

The Alpha Project is a unique 3-week project where each week builds on the one before. It is crucial that we guard the continuity of the schedule and the environment it creates. Therefore, with the exception of emergencies, immediate family weddings, personal graduation ceremonies, and military service, no out-of-town trips are permitted. Please review the Alpha Project "Out-of-Town Policy" linked here for reference.

Please describe below the type and date(s) of any permitted out-of-town trips that you anticipate between May 11-31. If none, please type "NONE" to indicate that you will be present for the entirety of the Alpha Project.*

Are you able to attend the Summer Leaders Training Retreat April 11-13 in Charleston?*

YesNo

If not, please explain:

The vast majority of students will pay for their Summer Project by fundraising. Please review the Summer Projects Fundraising & Cancellation Policies. This will be further explained at your campus's fundraising training in the spring.

Any cancellation request must be submitted via the Summer Project De-Commitment Form. De-commitment from:

The Alpha or Alpha "E" Project on or prior to April 4, 2025, will be subject to a $250 cancellation fee that will be drafted from the pay method used on your previously submitted Commitment Form. De-commitment after April 4, 2025, will be subject to a $500 cancellation fee.
The Cross-Cultural Project prior to the purchase of team flights (estimated by March 1, 2025 for CO Charlotte and February 1, 2025 for CO Charleston), will be subject to a $250 cancellation fee that will be drafted from the pay method used on your previously submitted Commitment Form. De-commitment on or after the date of the purchase of team flights, will be subject to a cancellation fee equal to the amount of non-refundable costs incurred at the time of your de-commitment.

Any funds donated towards your participation in the Alpha Project prior to your de-commitment cannot be refunded to donors due to IRS regulations.

Do you agree to the above Summer Project Fundraising & Cancellation Policies?*

YesNo

For CO Charlotte Students: Do you plan to participate in the RISE Initiative (click link below for more info) for your fundraising process or just raise support for your Summer Project?

RISE Initiative (CO Charlotte students please complete the RISE Initiative Commitment form linked below)Summer Project onlyNot sure yet

CO Charlotte RISE Initiative Information

CO Charlotte RISE Initiative Commitment Form

Health Insurance Company Name*

Health Insurance Company Phone Number*

Area CodePhone Number

Name of Primary Policyholder*

Policy/Group Number*

Please describe below any special medication and/or health information that would be necessary or helpful for Summer Project staff to know (i.e. relevant medical history, current medications, food/drug allergies, etc).

The undersigned hereby gives permission, in the event of an emergency, if he/she is unable to give consent or a parent/guardian cannot be reached, to the physician or dentist selected by Campus Outreach leadership to hospitalize, secure proper treatment, and/or order an injection, anesthesia, or surgery as deemed necessary during the program described herein.

Every activity sponsored by Campus Outreach is carefully planned and adequately supervised by mature adults; however, even with the best of planning and precaution, unforeseen events can occur. The undersigned agrees to assume and accept all risks and hazards inherent in Campus Outreach related activities. They also agree not to hold this organization or its employees liable for damages, losses, or injuries to the person or property undersigned that might arise out of, in route to/from, while in residence, or as a result of any involvement or participation by said student in the program described as the 2025 Alpha Project, Alpha "E" Project, and/or Cross-Cultural Project held between the months of May and July, 2025.

This authorization, consent, and waiver of liability will remain effective, unless revoked in writing by the undersigned, and delivered to Campus Outreach.

Signature*

My Products

Summer Leader Commitment Deposit$1.00

This nominal commitment fee secures your place in the 2025 Summer Project(s) to which you are committing and serves as a backup payment method in the event of de-commitment.

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Billing Address

Street Address

Street Address Line 2

CityState

Zip Code

Summer 2025 Leader Commitment Form

Authorization & Consent