United Way Alternative Spring Break

2010 Alternative Spring Break Application

Spring Break will be here before you know it, so now's the time to plan for an unforgettable experience. United Way is now accepting applications for the 2010 Alternative Spring Break (ASB). Please fill out the fields below to apply to help rebuild homes and lives on the Mississippi Gulf Coast.

(Please keep in mind that the ASB application may take you 30 minutes or more to complete.)

If you are a member of the ASB Alumni or applying to be a Team Leader with Student United Way Impact Exchange, you must click here to fill out the Team Leader application.

Items marked with an asterisk (*) are required.

GENERAL INFORMATION:

*First Name:

*Last Name:

Middle Initial:

*Gender:

*Birth Date (mm/dd/yyyy):

*T-Shirt Size:

Female

Male

How would you identify your racial/ethnic group? (Select all that apply)
(NOTE: This information is sought for data collection only and will not be used as a selection criterion.)

African American/African/Black

Native American/Alaskan Native

Asian American/Asian/Pacific Islander

Latino/Hispanic

White/Caucasian

Other (please specify)

*Primary E-mail Address:
(Please keep in mind that this will be our primary source of contact with you-notification of acceptance if accepted)

*Confirm Primary E-mail Address:

*Phone (Cell/Mobile):

*Phone (Daytime):

Phone (Evening):

NOTE: If you are having technical difficulties applying with the application process, please email:

ASBMS@local.unitedway.org