BREAKOUT TRIP PROPOSAL APPLICATION for 2016-2017

APPLICATION DUE: APRIL 4th, 2016 at 11:59PM EST

LEADER TRAINING IS A REQUIRED PART OF ACCEPTING A TRIP

April 9th (10-4pm) Frist MPR

Thanks for proposing a Breakout trip! This form is to be used to submit a Breakout Princeton Trip Proposal for Fall 2016 or Spring 2017. Remember to also submit your leader application Please complete and submit this application by 11:59pm.

It is strongly suggested that you complete your answers to these questions in a separate document and then cut and paste before submitting in order to avoid losing your answers.

Before you begin, please be sure to read the Desinging Your Trip Outline, which walks through the many issues you’ll need to take into consideration when crafting your proposal.

For examples of previous trip topics and destinations, see Past Breakout Trips.

Process: Final acceptance of all trips must complete an interview with staff.

LEADER #1 INFORMATION

First Name *

Last Name *

PU ID: *

Email Address *

Phone Number: *

Identify names of potential co-leaders

The Breakout trip approval is not dependent on already having a co-leader. If you have not identified a co-leader the Pace Center Staff and Breakout Coordinators will assist. Each trip will only have 2 co-leaders.

First Name

Last Name

First Name

Email Address

Last Name

Email Address

PROPOSED TRIP INFORMATION

Proposed topic and title:
(Examples: Health and wellness, arts, education, environment, etc.) *

Proposed locations or regions (please indicate 2-3 possible sites): *

Your trip is most closely related to which theme? *

Semester the Trip will take place *

Fall

Spring

Either

Total estimated budget: (you will upload your complete budget proposal sheet below)
*

Means of transportation you intend to use *

Public transportation

Vans

Flights

Describe the topic/issue of your trip and why it's important to you. (500 words) *

0/500 words

What are the learning goals for the trip? What impact do you expect to have on the community and/or issue? (500 words) *

0/500 words

Please identify 3-5 relevant articles, news sources, and/or documentaries that describe all or some aspects of your trip issue. Provide direct links when available. *

What university departments and/or individuals will you be working with (e.g. a professor, graduate student, or staff to help you organize educational components of the trip)? (500 words) *

0/500 words

What organizations do you expect to work with (e.g. government officials, a church for housing and food, a social service agency for a visit and some work, etc.)? (500 words) *

0/500 words

Do you have any existing faculty, community, or other relationships that will be helpful to developing your trip? *

Yes

No

If Yes, please identify these people and their affiliations. (200 words)

0/200 words

What is the status of any communication you've already had with the above relationships? (250 words)

0/250 words

If you have not identified a co-leader, what leadership skills are you looking for? Would you like help in identifying a co-leader? (150 words)

0/150 words

What pre-trip activities do you propose prior to departing for your trip? Identify pre-trip goals for participants and your plan to meet these goals. Develop and include here a rough itinerary and timeline for your pre-trip activities.

You must have at least 4 pre-trip group activities that orient and educate participants about the topic of your trip. Think about teambuilding and understanding the issue- e.g. meeting and sharing initial impressions of the social issue, bring in a professor to facilitate a discussion, attend a lecture together, watch a documentary film, etc. *

0/500 words

Describe anticipated trip logistics and other details (housing, meals, transportation during the trip and from/to Princeton, etc.). What supplies will you need for your trip and activities? (250 words) *

0/250 words

What activities do you propose during the trip? Provide a rough draft of a daily agenda for the week. Be sure to note time and process for student reflection on both service and learning. (500 words) *

0/500 words

What ideas do you have for post-trip activities and how will you help participants stay involved with the issue? (250 words) *

0/250 words

BUDGET: Please click here to download the Excel budget spreadsheet. Fill in estimated trip expenses, then save the spreadsheet on your computer, renaming it by replacing yournamehere with your own name. Upload your budget by clicking on the browse button below and navigating to the location where you have saved the file on your computer. We understand that this budget is a rough estimate and will be revised later as your trip is further developed.

Please use this space to provide any additional information that you think will be useful in helping us evaluate your trip proposal. (100 words)

0/100 words

How did you hear about proposing a Breakout Trip? *

If you chose "Other", please explain

Community Service Kickoff	Fliers on campus
Fall Reflections and Directions program	Pace Center website
Pace Center e-newsletter	Emails from Pace Center
Emails from academic depts	Word-of-mouth
Facebook/Twitter	Current/past Breakout leaders/participants
Other