2017 Spring Breakout Princeton

Trip Participant Application

Application Deadline: Sunday, Janurary 8 2017 by 11:59PM EST

Please complete and submit this application online. Applications submitted after the deadline will not be considered.

Eligibility and Selection Criteria:

To be eligible to participate in Breakout Princeton, the following requirements must be met:

Be a currently enrolled Princeton undergraduate or graduate student
Have a passion for learning about and taking action to address important public issues
Be able to fully participate in all required pre-trip meetings, the entire trip, and the post-trip gathering
Be free from disciplinary probation at the time of application and throughout the Breakout experience

Participant applications will be evaluated by designated trip leaders, Breakout Princeton coordinators, and Pace Center staff, using the following criteria:

Ability to participate fully in the program before, during, and after trip
Eagerness to learn about a new community and a public issue of interest
Ability to fully engage and contribute to a diverse group of peers
Ability to be flexible, open-minded, collaborative, reflective, and respectful of community context

In reviewing applications, we strive to make each trip representative of Princeton’s diversity. We welcome all backgrounds and identities. We encourage applicants to share however much of their story they are comfortable with, knowing that Breakout is a place where they will be heard.

Fees:

In an effort to make Breakout Princeton accessible to all students, the Pace Center for Civic Engagement has eliminated participant and trip leader fees for all Breakout Princeton Trips!

Continuing in the vein of opportunity, new Breakout Princeton Policy states that students may serve as a participant once and a trip leader once. If the student wishes to remain involved, the next opportunity is to pursue leadership positions within Breakout -- such as a Trip Coordinator or Board Member.

For any questions or concerns please contact Pace Center Program Coordinator and Breakout Staff Advisor, Eliza Blades at eblades@princeton.edu or call at 609.258.9746.

Background Information

Full Legal First Name *

Full Legal Last Name *

Preferred/Nickname

Gender: *

PU ID (9-digit number on your Prox, NOT your netiD) *

Email Address *

Date of Birth *

Class year *

Phone Number *

Residential College (Juniors and seniors must also note residential college affiliation) *

Department (if known)

I am a: *

Princeton undergraduate student

Princeton graduate student

Are you an international student? *

Yes

No

From which country?

Have you successfully passed the University's van certification road test? *

Yes

No

If you are not car or van certified by Princeton, are you willing to become certified? *

Yes

No

What extracurricular activities, clubs, or other programs will you be involved with in the Spring?

Have you applied for a Breakout trip in the past and not been selected? *

Yes

No

Have you served as a participant on a Breakout Princeton Trip in the past? * 🛈

Yes

No

How did you hear about Breakout Princeton? *

Essay Questions

To ensure your answers to the questions below are complete and intact before hitting Submit, we recommend writing out your responses in a separate word document that you then save. Then, as you complete this form, cut and paste your final answers from this saved document into the appropriate fields below. Answers should be no longer than 300 words.

1. Why do you want to go on a Breakout Trip? What are your personal learning goals if you are selected? *

2. What does civic engagement mean to you? Describe a time when you felt you belonged to and were responsible for a community. *

3. If we were to ask your peers and professors to name 3 strengths and 3 challenges of yours, what would they say? *

4. Breakout trips involve interacting with communities that have the potential to be very different from the Princeton University community. Describe a time when you were pushed out of your comfort zone. What did you learn about yourself? *

Trip Preferences

Breakout Princeton is sponsoring 6 trips during the upcoming break. The size of each trip group is limited to 10 students to ensure the safety of the group and the quality of experience for participants.

The Breakout trips require participants to be extremely flexible. Living simply is a value of Breakout Princeton, meaning conditions may be different than what you are accustomed to (e.g. sleeping on a floor or doing demanding service work) and plans might change unexpectedly

To facilitate the trip placement process, please rank your top 3 trips in order of your preference.

When you have completed ranking your trip preferences, please answer the cooresponding trip-specific questions for your top 3 trips. We will do our best to place you within your preferences, however, we cannot guarantee there will be space.

For a brief description of each trip featured this Spring 2017 semester please visit the Pace web-site.

Which trip is your first choice? *

What is your second choice? *

What is your third choice? *

Trip Specific Questions

Becoming American: Navigating Culture and Identity in Immigrant Enclaves

How have your communities and spaces played a role in the way you understand and express your own identity? *

0/400 words

Transforming Tulsa: Philanthropy as a Vehicle for Social Change

How have you benefited from or interacted with philanthropic organizations in your life, and what role do you think philanthropy should play in the provision of social services? *

0/400 words

Urban Addiction: Institutional Approaches to Drug Abuse

What is a social or environmental factor that could contribute to the rate of drug abuse in a community? Explain its significance. *

0/400 words

Opportunity Gap: Pipelines of Education for Students of Color

What privileges have you been afforded in your educational career? How have those experiences shaped the way you think about access to education for others? *

0/400 words

Community Development: Urban Art (FRESHMAN ONLY)

Describe an experience with art (visual, dance, music, theater, etc) that changed your perception about a community, identity, or social issue. *

0/400 words

Criminal Justice: Incarceration and Reform (FRESHMAN ONLY)

What are some assumptions made about incarcerated individuals? Where do those assumptions come from? *

0/400 words

Waiver to Inquire about Disciplinary Records

Students on disciplinary probation at the time of their application are not eligible to participate in Breakout Princeton. To verify your eligibility, please read the waiver below and indicate your consent to inquire about your disciplinary records. Information related to your disciplinary records will only be shared with Pace Center staff.

In submitting this application, I permit the Pace Center for Civic Engagement to inquire about my student disciplinary records at Princeton University, 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 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 provide my consent to the waiver above.

No, I do not provide my consent to the waiver above.