Local Phone #:
Local / Campus Address:
Year of Graduation:
Foreign travel experience(s)?
This application form should be used to apply for either a Winter or Summer Break INTERNATIONAL SERVICE TRIP coordinated through Campus Ministry. Service trips vary based on the geographic location, length of trip, and type of service.
I wish to apply for an International Service Trip during the following University scheduled Break (select only one):
During the University Break that I selected, I wish to participate in the following trip:
Name of program:
Location of program:
Dates of Program:
Did you attend an Information Session about this trip?
Additional Comments / Program requests:
Have you participated in a service trip (National or International) previously?
If yes: When?
Program with which you worked:
List up to five (5) community service projects / programs in which you have participated within in the past two years.Project / Program - Type of Service - Date(s)
How would you describe your general health?
Do you have health insurance coverage?
Do you have any health concerns that we should be aware of? If so, please explain (i.e. diabetes, heart problems, back problems, allergies, etc.) Medical clearance may be necessary.
Do you have any dietary restrictions? Please explain:
Please rank yourself in the following areas:
Willingness to accept responsibility
Unable to Judge
Ability to work collaboratively
Ability to set priorities
Ability to follow-through
Effective time management
Initiative and Self Motivation
Awareness of social justice concerns
Acceptance of differences
Willingness to participate in group reflection and prayer experience
Readiness for immersion in a developing country
Sense of Humor
Of the Previous/Current Community Service Programs you listed in Section III, please choose the one that has had the greatest impact on you; describe how you have been impacted and why the experience has been significant for you (up to 250 words).
Describe your motivation for participating in Campus Ministry’s International Service Trip Program (personal, academic, and/or spiritual) (up to 150 words):
Describe your involvement in a group setting (i.e. team, club, committee, class group, etc). What were the highlights of your involvement with this group? What were the challenges? Why?
What personal strengths/characteristics would you identify as potential assets to the group as well as to the persons you will serve?
What personal weaknesses would you identify as potential challenges to the group experience?
In what ways do you hope to grow as a result of your participation in the International Service Trip Program (academically, personally, spiritually)?
What, if anything, do you foresee as being a challenge for you to participate in this program ?
Participating in the International Service Trip Program involves a time commitment: Fundraising, Attendance at all pre-trip preparation meetings (typically 6-8 meetings; each is 2 hrs in length), Pre-Trip Community Building Retreat, Trip itself, Post-Trip meeting and follow-up. Considering your academic, extra-curricular, and work commitments, are you able to make this time commitment?
If No, please explain (up to 100 words):
Do you have any questions or concerns that you would like during the interview procces?
Please list the three (3) persons [Marywood faculty/staff, family member, peer] you have requested to complete a Recommendation Form on your behalf for this selection process.
Marywood University faculty/staff persons who know you well and that you have requested to complete a recommendation form for you:
Family member who knows you well and that you have requested to complete a recommendation form for you:
Peer who knows you well and that you have requested to complete a recommendation form for you:
Campus Ministry | Swartz Center for Spiritual Life | email@example.com | (570) 961-4723
Copyright ©2013 by Marywood University. All rights reserved.
Sponsored by Sisters, Servants of Immaculate Heart of Mary
Comments to Marywood University Web Development Office: firstname.lastname@example.org