Get Outside With Reconnect Earth
Filling out this application is the first step to join our July 18-21 Mountain Glaciers & Meadows trip. Spaces are limited, so apply today!
Basic Info
Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
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example@example.com
Age
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City/town and state/province you'd be traveling from
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School you go to, if applicable
Year in school, or what you're doing currently if not in school
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The questions below will help us get a feel for why you'd like to join a Reconnect Earth trip this summer
What made you want to apply for a Reconnect Earth summer trip?
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What's one or more social, environmental, or other issue you would like to be able to take action on? List as many as you like!
Please briefly describe your level of experience with hiking, camping, or other outdoor activities (having experience is not required).
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Please briefly describe any experience you have with activism, grassroots organizing, or advocating for causes you care about (having experience is not required).
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These questions will help us make sure you'll be able to participate safely in a trip
How much exercise do you get in a typical week? Please provide the type of activity, duration, and number of times per week (example: biking, 45 minutes, 3 times per week).
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What is the most physically challenging activity you engaged in recently? Please describe the activity and how long it lasted.
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Do you have a history of any of the following physical or medical conditions that might make outdoor activities challenging? Please check all that apply.
Asthma/breathing problems
Anaphylaxis
Heart condition
Diabetes
Seizures/neurological issues
Gastrointestinal tract issues
Chronic pain
Fainting/dizzy spells
Blindness
Deafness/hard of hearing
Physical disability
Recent musculoskeletal injuries (in the last two years)
Recent surgery (in the last two years)
Other
If you checked any of the physical/medical conditions above, please provide some details about your history with the condition and how you think it might affect your participation in a Reconnect Earth trip.
Do you have any of the following cognitive, behavioral, or emotional conditions?
Anxiety
Depression
Eating disorder
Autism spectrum/Asperger's syndrome
Drug/alcohol addiction
Obsessive Compulsive Disorder (OCD)
Post-Traumatic Syndrome (PTSD)
Other
If you checked any of the cognitive, behavioral, or emotional conditions above, please provide some details about your history with the condition and how you think it might affect your participation in a Reconnect Earth trip.
If you checked any of the physical/medical OR cognitive, behavior, or emotional issues above, what could we do to help you participate more comfortably?
Please list any known allergies you have:
Do you have any of these dietary restrictions?
Vegan
Vegetarian
Kosher
Gluten-free
Dairy-free/lactose intolerant
Other
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Reconnect Earth strives to make our trips accessible to participants of all genders, races, and economic backgrounds. With this in mind, it's helpful if you fill out the below information.
How would you describe your race/ethnicity?
What gender pronouns do you use?
What would you say is your economic class background?
Working class/low-income
Middle class
Upper class
Do you identify with any of the following? Please check any that apply.
Speaker of more than one language
Immigrant
Member of the LGBTQ+ community
First-generation college student
Veteran
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Scholarship application (optional): Please fill out this section if you wish to request a scholarship. If you're not asking for a scholarship, you can skip this page.
Would you like to request
A 50% scholarship
A 75% scholarship
We want our trips to be accessible for participants of all income levels. Would you please briefly describe your current financial situation to the degree you feel comfortable?
If you did not receive a scholarship, would you still be able to participate in a Reconnect Earth trip?
Yes, I would still participate
No, I could not participate
I could participate but would choose not to
I'm not sure
Have you looked into ways you might be able to raise money to help cover tuition, for example from your school or through creative fundraising ideas? If so please describe.
What is one or more way you think you could use experiences from a Reconnect Earth trip to benefit other people around you after the trip is over?
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Just a few last things...
I agree to Reconnect Earth's Assumption of Risk policy
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Yes
I understand photos from the trip may be used on Reconnect Earth's website or other materials. If I don't consent to appearing in photos, I will inform Reconnect Earth in writing no later than the end date for the trip.
Yes
Did another trip applicant refer you to this application? If so, what's their name?
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