Formulario

UConn Empower Summer 2016 Trip Application

Please complete and submit by Noon on Saturday, February 6, 2016.
El Cidral, Dominican Republic

General Requirements & Trip Information
UConn Empower will be traveling to El Cidral, Dominican Republic to work with Service for Peace, a locally based NGO that works with the community in order to prioritize their needs. The people would like to focus on the community’s development and organization, starting with the local school, public electricity system, and women’s work initiative. We hope “to be a small part of this large project” at least, if not a significant one! Any and all participation is welcome and appreciated.
- Applicants must be active members of UConn Empower for Spring 2016.
- Applicants must be 18 years or older at time of trip.
- Applicants must have a valid governmental ID or passport (if not a citizen).
- Applicants must be in good health such that the student is able to perform physical labor in outdoor conditions.
- Valid medical insurance.
- Must be able to pay each installment on the designated due date, specifically the $200 deposit by Sunday, February 21, 2016.
This application is open to both UConn Empower student members and non-members. However, all applicants must be full-time undergraduate students at the University of Connecticut. Current membership and previous participation in UConn Empower will be factored into the selection process. Non-members, however, are highly encouraged to apply as they can be picked over members on merit.

After the general application process, desirable candidates will be selected for interviews with the Executive Board.

UConn Empower does reserve the right to remove anyone from the trip without refund of their deposit. This will be in response to a lack of commitment to any of the pre-trip meetings and activities.

If you have any questions, comments, or concerns about the application, deadlines, requirements, or meetings please contact us at uconn.empower@gmail.com.
Please confirm that you have read and understood the Trip Information and General Requirements above.*

YesNo

Application Information

Background Information
Official Name*

First NameMiddle InitialLast Name
Date of Birth*

MonthDayYear
University ID*

Student IDNet ID
Campus*

StorrsOther
Degree*

Major(s)Minor(s)Expected Graduation Month
I am a citizen of*

Personal Contact Information
Permanent Address*

Street Address

Apartment Number (If Applicable)

CityState / Province

Postal / Zip CodeCountry
UConn Address*

Street Address

Apartment Number (If Applicable)

CityState / Province

Postal / Zip CodeCountry
Cell Phone Number*

Area CodePhone Number
E-mail*

Parent/Guardian Contact Information
First Parent or Guardian*

First NameLast NameRelationship to Traveler
Daytime Phone*

Area CodePhone Number
Nighttime Phone*

Area CodePhone Number
Second Parent or Guardian*

First NameLast NameRelationship to Traveler
Daytime Phone*

Area CodePhone Number
Nighttime Phone*

Area CodePhone Number

Short Answers

Questions are required to be answered by ALL applicants.
1. Describe one experience in which you personally took an initiative in any way to help a community. (We recommend you type your response in another file and paste it into the form afterwards. The form will be saved in your browser for two days.)*
2. Describe an instance of conflict or disagreement with another person. How did you respond in the situation? (We recommend you type your response in another file and paste it into the form afterwards.)*
3. What do you hope to personally get out of this trip? (We recommend you type your response in another file and paste it into the form afterwards.)*
4. Do you offer any other skills, qualities, or experiences that could enhance the trip or travel group?*
5. Have you ever worked or volunteered with a group or non-profit organization before? If so, in what capacity was your involvement?*
8. Do you have the time to commit to the biweekly meetings for the trip team as well as the weekly general-body meetings for UConn Empower?*
7. Have you ever travelled outside the US?*

YesNo
If you answered yes, where and when?
Are you applying for the Assistant Trip Director position?*

YesNo

Assistant Trip Director Application

The following additional questions are for Assistant Trip Director applicants ONLY
The assistant trip director’s primary role will be to work alongside the trip leader and support them in all team related efforts. They will aid the trip leader in establishing team dynamics and effectively maintaining interpersonal communication and relations, and effectively assist them in all trip related tasks. Their focus will be to engage the trip members as much as possible, in an effort to establish team camaraderie and a positive morale. They will aid the trip director in keeping track of overall project progress and will ensure each trip member is well informed.
1. Explain how you will run the trip team along with the trip director (how you will delegate responsibility, what collaborations will you start, keeping members engaged and informed, integrating work into the trip this summer, creativity etc.). Keep in mind that the board will help you out in the beginning!*
2. If you held a leadership position in other clubs on campus, name an example you went beyond your job or position responsibilities to benefit the club.*
Do you offer any other skills, qualities or experiences that will make you a great project leader?*
How much time a week can you devote to be a team/project leader?*

Expectations for Trip Participants
Please check off to acknowledge the following trip participant guidelines:*

I confirm that I have the time to attend Empower’s weekly general-body meetings.I agree to pay the $200 trip deposit by the Sunday, February 21, 2016.I understand that the deposit for the trip is nonrefundable.I understand that I will not be reimbursed for the trip cost if I withdraw from trip for any reason after Friday, March 11, 2016.I understand that as a trip member there will be a MANDATORY weekly trip meeting and failure to attend these meetings will result in explosion from the trip.
I affirm that I will provide the necessary fee and materials by the trip deadlines indicated to me in an email sent after my selection as a participant. I acknowledge that if I fail to adhere to any of the deadlines or guidelines laid out at any point through correspondence with uconn.empower@gmail.com, I may have my spot on the trip revoked and my payments to UConn Empower partially refunded with the exclusion of the trip deposit. UConn Empower reserves the right to revoke the privilege to participate on the trip at its discretion, based upon factors including but not limited to inability to work well with other members, disregard for pre-trip processes, or other behavior that inhibits UConn Empower’s ability to travel in Dominican Republic. By signing below, I also agree to attend all UConn Empower Trip Team and General Body Meetings to the best of my ability, and should there be a legitimate conflict, I will work with the trip coordinator to remain as involved as possible. *

Digital SignatureDate MM/DD/YYY
Should be Empty:

General Requirements & Trip Information

Short Answers

Assistant Trip Director Application