United Way Alternative Spring Break - Student United Way Impact Exchange Application

2010 Alternative Spring Break - Student United Way Impact Exchange 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 Impact Exchange Alternative Spring Break (ASB). Student United Way Impact Exchange ASB is designed as an opportunity for Student United Ways to mobilize young adults from their campuses to engage in a week of service hosted by another United Way from somewhere across the UW system. If your Student United Way has lined up an Impact Exchange ASB, please fill out the following information to apply to help rebuild homes and lives in different communities around the nation.

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

NOTE: If you are applying to participate as a Team Leader, click here to complete the Team Leader application. There is no need to fill out this application as well. Thanks.

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