Summer Break: New Orleans Thailand Alaska has a separate application here.
Email:
Name:
CPO:
Phone:
Date of Birth:
Year at North Park:
1st 2nd 3rd 4th Other
Do you speak another language? If so, which one(s)?
Do you have a U.S. passport?
Yes No
Emergency Contact:
Emergency Contact Address:
Emergency Contact Phone:
Health Insurance Company:
Policy Number:
Contact Phone:
1. Please comment on any areas of expertise or experience that you have that would be an asset to this trip? 2. Why do you want to go on this trip? 3. What concerns do you have about going on this trip? 4. What other UMin programs have you been involved with in the last year? Please specifically answer if you have participated in Urban Outreach or Sankofa. 5. What cross-cultural experience have you had?
