2021 Alternative Break Scholarship Application Name University/College * First Name * Last Name * Email * Phone * 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) * Yes No I’m not sure 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? * Yes No 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 from the week Reference Please list someone that we can contact to provide a reference for your group. It can be an adviser, professor, mentor, etc. Reference Name * Connection to Reference * Reference’s Email * Reference’s Phone *
