Breakout 19-20 First Year Trip Leader Cohort Application

Thanks for your interest to be a Breakout Princeton First-Year Trip Leader!

To apply, all leaders must complete and submit this form.

APPLICATION DUE: November 22nd 11:59 PM, EST

LEADER TRAINING REQUIRED

Before completeing the applications, please review the Pace Center Breakout Website and Trip Leader Requriments.

Breakout Princeton is accepting applications for First Year Leaders to develop trips in the areas of arts and community development. We encourage you to apply with a partner as creating in community is important. While you apply individually, you have space to share a potential partner's name here.

Feel free to contact Geralyn Williams, geralynw@princeton.edu, at the Pace Center, with any questions.

Suggestion: Complete your answers to these questions in a separate document before submitting, then cut and paste into this form to avoid losing your answers.

Check the box below to confirm that you have read and understood the Trip Leader Requirments. *

I have read the Breakout Trip Leader Guidelines.

Part 1: BASIC INFORMATION

Full Legal First Name *

Full Legal Last Name *

Preferred/Nickname

Gender Pronouns (if you use them): *

Class Year *

PU ID: *

Princeton Email Address *

Phone Number: *

Date of birth: *

Other Email Address

Major (if known)

Certificate(s)

Affiliated residential college (juniors and seniors: please also list your residential college) *

Name of potential co-leader (if applicable) *

Are you car-certified by Princeton? *

Yes

Are you van-certified by Princeton? *

Yes

If you are not car- or van-certified, are you willing to be? Note: At least 2 car/van-certified drivers are required for each trip.

Yes

Are you willing to drive for a Breakout trip? *

Yes

Name of person who could serve as a reference (e.g. employer, faculty, Princeton administrator):

Reference relationship to you:

Reference email:

Reference phone:

How did you hear about Breakout Princeton?

Part 2: LEADERSHIP INFORMATION

1. Why do you want to be a Breakout trip leader? What can you contribute, and what do you hope to gain from being a trip leader?
*

2. Explain why you think you are person to lead others through an exploration of the issues and communities? *

3. Have you participated in, or organized, a break trip or other civic engagement project before? Please describe your most closely related civic and project leadership experiences and provide examples of how you’ve demonstrated skills or qualities that prepare you to be an effective Breakout leader.
*

4. List any practical skills you have that you think would be valuable, such as CPR certification, ability to lead trainings, practice cooking large meals, etc. *

5. Share one experience you have had leading a group. What challenges did you face? How did you accomplish your goals?
*

6. List your anticipated major activities for the semester and the expected time commitment of each (total credit hours, sports, jobs, other programs or organizations, etc.). How much time each week per semester, will you devote to organizing your Breakout trip? *

7. What are the areas in which you feel you have talent and excel?
*

8. What are some of the issue areas you would like to explore in relation to arts or community development? *

9. How do you envision your future involvement with community engagement and service-learning at Princeton? *

Part 3: Confirmations

I understand that if chosen, I will need to be available for leader trainings and cohort meetings and will be responsible to uphold the trip leader agreement. *

Yes, I have read trip leader responsibilities.

No, I need more details and I will be in touch shortly.

Students on disciplinary probation at the time of their application are not eligible to participate in the Breakout program. Pace Center staff is only able to verify your eligibility with your consent noted by the waiver below. Please read the waiver and indicate your consent. Note that any information related to disciplinary records will be shared only with University staff.

In submitting this application, I permit the Pace Center for Civic Engagement to inquire about my student disciplinary records at Princeton, and I permit the Office of the Dean of Undergraduate Students (ODUS) to release such records to the Pace Center. Information from other offices at Princeton, e.g. residential colleges or others, may be requested as part of the application review process to ensure that all students can have a safe and productive experience. I understand that decisions on individual applications are made by the Pace Center on a case-by-case basis and that any information received by the Pace Center will not be released to other students or any third parties. *

Yes, I consent to the above.

No, I do not consent to the above.