2020 Participant Application Applicant must be a current Williams College student and may apply to only one trip. Please review the Trip Summaries before applying, and address specific questions to the trip organizers. Each participant will be asked to make a personal financial commitment towards the trip's expenses, as detailed on the Trip Summaries page. This application will be sent directly to the organizers of the trip you have selected, and also reviewed by members of the Break Out Trip Committee. Trip organizers may respond to applicants with additional follow-up or trip-specific questions. The application deadline is Sunday, December 15, 2019. Your InformationName* First Last PronounsClass Year*2020202120222023Williams/PeopleSoft ID#*Please include only the 7 numerical digits without the preceding W.Unix ID*Preferred Email* Enter Email Confirm Email Phone*SU Box*Major(s) or Possible Major(s)*Please list your most significant extracurricular activities during the 2019-2020 Academic Year.*Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Winter Study Availability*Please indicate your availability during Winter Study, as some BOT groups do important planning, group-building and preparatory sessions during January. What dates will you be on-campus, if any? Will you have email access at all times, and if not, is there an alternate method for trip organizers to reach you?How did you hear about Break Out Trips?*Please list all that apply (Daily Messages, all-student email, Center for Learning in Action website, from a friend, past participant in Break Out Trips, student organization, other campus offices or departments, etc.)Trip SelectionTrip summaries are available at learning-in-action.williams.edu/opportunities/bot/2020-trip-summaries.2020 Trip Preference*You may select only one trip, and your application will be sent only to the organizers of that trip.An Ephed Up Food SystemHave you participated in a past Break Out Trip?*YesNoIf "Yes," which trip(s) and in what year(s)?Additional QuestionsAre you interested in helping to coordinate some aspect of the trip?*Trip leaders are encouraged to designate other participants on their trips to assist in coordinating various important aspects of the trips. If you would be willing to serve in one of these coordinating roles, please check the appropriate box(es) below. Travel & Logistics Research None of the above What would you bring to the group and to the project?*Please include relevant skills and leadership experience.Please list any certifications you have.*(e.g., CPR, EMT, WFR, College-approved student driver, etc.)What language(s) do you speak, and at what level of proficiency?Short Essay*Why are you pursuing this service experience? Does this trip relate to your academic studies, vocational aspirations or other personal commitments? What do you hope to contribute to the community, and what do you hope to learn by going on this service trip?Is there anything else you'd like us to know?Financial AidI give the Financial Aid office permission to release to the Center for Learning in Action the information of whether or not I am considered low, medium or high need for financial aid. This classification will then affect the amount of aid I receive toward my individual out-of-pocket trip contribution. Please type your full name in the box below if you agree.AgreementBy clicking "Submit," you certify that the information you have provided in this application is accurate and complete to the best of your knowledge. You also understand that, based on your application to participate in a Break Out Trip, the Center for Learning in Action reserves the right to discuss your candidacy with the Dean's Office, which may include a review of your academic and disciplinary records at Williams College.Applicant Signature* First Last Date* Date Format: MM slash DD slash YYYY
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