Alternative Break Financial Assistance Application

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Please list someone that we can contact to provide a reference for your group. It can be an adviser, professor, mentor, etc.

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University/College *

Address Line 1 *

Address Line 2

City *

State/Province *

Zip/Postal Code *

Country

First Name *

Primary Contact

Last Name *

Email *

Phone 1 *

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Estimated Group Size *

Your group must have a MINIMUM of 6 and a MAXIMUM of 10.

Spring Break Start Date *

Spring Break End Date *

Has your group participated in a service trip or an Alternative Break in the past? (for planning purposes, has no effect on selection) *

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The Alternative Break financial assistance is need-based. Priority will be given to groups that have historically faced barriers to accessing outdoor programing. Please describe if your group fits these criteria. *

Do you have alternate sources of funding to participate in an AHS Alternative Break or similar service trip? *

Are you able to comply with the Alternative Break financial assistance recipient requirements? *

Group Size of 10 -18+ years of age. Group is responsible for arranging travel ($3,000 travel stipend provided). Group is responsible for purchasing and preparing food ($750 food stipend provided). Group must be willing to provide photos and/or video.

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Reference Name *

Connection to Reference *

Reference's Email *

Reference's Phone *

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