Page 1 of 6. Applicant's Name: Packet Contents

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1 ASB Site Leader Application Due: Friday, November 3, 2017 by 4:00pm Please submit a printed and signed application with the required attachments to OSV office, SSA T, by the deadline. Applications may also be ed to volunteer@utdallas.edu or faxed to Applicant's Name: Packet Contents I. Cover Page.. Page 1 II. Overview of Site Leader Responsibilities.... Page 2 III. Overview of Site Leader Responsibilities - Continued.... Page 3 IV. Site Leader Application - Applicant Data.. Page 4 V. Trip Preferences to Site Lead. Page 5 VI. Site Leader Questions. Page 6 General registration for team participants will be available online on Friday, December 1 st at 12:00pm (noon). For Official Use Only: Upon submission of application, check for completion of each page and initial corresponding boxes. Page 1 Page 2 Page 3 Copy of valid driver s license or photo I.D. Copy of valid car insurance Copy of valid medical insurance card Page 4 Page 5 Page 6 Page 1 of 6

2 Overview of Site Leader Responsibilities Initial This is only an overview. Additional responsibilities and obligations will be discussed in training. Please initial next to each line. Application Dates and Reminders: Fri, Nov 3 Site Leader applications are due Fri, Nov 10 Site Leaders are notified of trip placements Fri, Nov 17 Site Leader payment is due Fri, Dec 1 at 12:00pm (noon) Online registration for team members begins If you are not selected to be a Site Leader, you will have the ability to register as a team member through general registration on December 1. However, if you are selected, you will not be permitted to switch from Site Leader to a team member. ASB Important Training Dates: Initial the following dates to confirm that you are available to attend. Site Leaders are required to attend all meetings and training sessions. Training sessions are listed below. Wed, Jan 10 ASB Leadership Meeting, 3:00-4:00pm, SSA Wed, Jan 24 ASB Leadership Meeting, 3:00-4:00pm, SSA Wed, Feb 7 ASB Leadership Meeting, 3:00-4:00pm, SSA Fri, Feb 16 Mandatory ASB Leadership Retreat, 3:00-5:00pm, TBD Wed, Feb 21 ASB Leadership Meeting, 3:00-4:00pm, SSA Tues, Feb 27 ASB Pre- Trip Orientation (Option A), 3:00-4:00pm, Galaxy Rooms (SU 2.602) Wed, Feb 28 ASB Pre- Trip Orientation (Option B), 10:00am- 11:00am, Galaxy Rooms (SU 2.602) Wed, March 7 ASB Leadership Meeting, 3:00-4:00pm, SSA Sunday- Friday, March ASB travel dates (may vary per trip) Wed, March 21 Post- ASB Leadership Meeting, 3:00-4:00pm, ATC List known conflicts (include date and reason): Team Meetings: I understand that it is my responsibility as a Site Leader to schedule, prepare and host team meetings through mid- April The specific times will be determined per team according to the majority of team members schedules. As a Site Leader, I am also expected to help coordinate and support my team s activities, including, but not limited to, service projects, team building and other ASB events. Trip Dates: I am available throughout the week of spring break, March 11-16, Trips may be scheduled at any time during these days. ASB participants must travel and stay with the group for the duration of the trip. Financial Obligation: I understand that my spot is not confirmed and I will not be able to go on the trip until my Alternative Spring Break fee is paid in full by the deadline, 4:00pm, Friday, November 17. Cancellation Policy - Air Travel: If I am on an air travel trip and cancel my participation, I understand that my airplane ticket is non- refundable and non- transferrable. Should I cancel my participation, I am responsible for making necessary adjustments and paying cancellation fees. Cancellation Policy Van Travel: I understand that a partial refund may be available for van trips. If I withdraw from an ASB trip, a refund will be determined by the date in which I cancel my participation. 50% refund for cancelations made before January 15 0% (no refund) if cancelation occurs after January 15 Page 2 of 6

3 Overview of Site Leader Responsibilities - Continued Initial Medical Insurance: I must have medical insurance in order to participate in Alternative Spring Break. I am required to provide current proof of medical insurance at least one month prior to departure. Student health insurance is available at or may be available through the Office of Student Volunteerism. It is my responsibility to request medical insurance if I am in need of coverage. Weapons, Drugs, Alcohol: Use and/or possession of weapons, alcohol, or illegal drugs is forbidden while travelling on a university sponsored trip. The Alternative Spring Break program prohibits the purchase and consumption of alcohol and illegal drugs by all participants, regardless of age, during all ASB events, including travel to and from sites. I understand that if I do not follow this policy, I will have to return to my place of residence at my own expense. Scholarship Release: Pursuant to The Family Educational Rights and Privacy Act of 1974, I hereby consent to the release of my grade point average [cumulative and prior terms(s)] and grade reports for prior terms to the Assistant Director of the Office of Student Volunteerism. This information may be used by the office for use in awards recognition and for verification of achievement of minimum academic standards. I understand that I must be a registered student at UT Dallas in good academic standing in order to serve as a Site Leader. This authorization shall remain in effect as long as I am enrolled at this institution, unless I revoke this authorization in writing. I have read and I agree to adhere to the Overview of ASB Site Leader Responsibilities. Signature: Date: Page 3 of 6

4 Alternative Spring Break 2018 Site Leader Application Complete this application and return to the Office of Student Volunteerism, SSA T by 4:00pm, Friday, November 3. Incomplete applications will not be considered. ASB fee is not due when application is submitted. ASB fee will be determined upon confirmation of Site Leader placement and will be due by 4:00pm, Friday, November 17. Applicant Data Name Student ID Classification Major Address 1 Cell Phone Number Home Phone Number T- Shirt Size City Address 2 State Zip Emergency Contact Name Emergency Contact Phone Number Emergency Contact Relation Do you have any previous ASB experience? Yes No Is yes, list previous ASB trip(s) and year(s): Site Leaders will be required to drive and must provide a copy of valid driver s license. Do you have a United States issued driver s license? Yes No Driver s License Number State Issued Expiration Please attach a copy of your driver s license and valid car insurance with this application. List any allergies or dietary needs: List any accommodations that you need, such as sign language interpreter, wheelchair access, etc. Page 4 of 6

5 Trip Preferences to Site Lead Location assignment will be discussed and confirmed once approved for Site Leader position. Each trip is dedicated to a specific social impact area. Social issues are listed in bold below. Site Leaders will be notified of their position by November 10. If selected, full payment will be due by 4:00pm, Friday, November 17. Air Travel Trips 1) LGBT+ & Ally Services Agency: Campus Pride Location: Charlotte, NC Fee: $ ) Shelter & Transition Services Agency: Ashby House Location: Salina, Kansas Fee: $ Van Trips 3) Affordable Housing Agency: The Fuller Center of NWLA Location: Shreveport, LA Fee: $ ) Animal Services Agency: Peaceful Valley Donkey Rescue Location: San Angelo, TX Fee: $ ) Disaster Relief Agency: Community Collaborations, Inc. Location: Gulf Coast, TX Fee: $ ) Environmental Conservation Agency: Galveston Bay Foundation Location: Galveston, TX Fee: $ ) Global Poverty Agency: World Hunger Relief, Inc. Location: Elm Mott, TX Fee: $ ) Healthcare Agency: Mercy Ships Location: Garden Valley, TX Fee: $ ) Park Preservation Agency: American Hiking Society & Trinity River National Wildlife Refuge Location: Liberty, TX Fee: $ ) Social Services Agency: San Antonio Food Bank Location: San Antonio, TX Fee: $ #1 Preferred Social Issue #2 Preferred Social Issue #3 Preferred Social Issue #4 Preferred Social Issue Please note that you are not guaranteed a Site Leader position by applying. If selected as Site Leader, your preference will be taken into consideration, but is not guaranteed. By completing this application, you agree that, if selected, you are willing to site lead any ASB trip. Signature: Date: Page 5 of 6

6 ASB Site Leader Questions Please answer each of the following questions. You may attach a separate sheet with your responses. 1) Briefly describe the most memorable experience of your previous ASB trip or favorite volunteer experience and why it has led you to want to become a Site Leader for ASB. 2) Respond to the following scenario: Due to transportation issues (flight delayed, van issues, etc.) your group can't get home for another day. Many of your members are concerned about academics and work in the upcoming week and tensions are high. How do you keep moral up and ease tensions? 3) If selected, what do you plan to gain from your ASB Site Leader experience or how do you want to grow in this service leadership opportunity? The University of Texas at Dallas is an affirmative action/equal opportunity university. Students with disabilities needing assistance contact TX Relay: RELAYTX Page 6 of 6