2016-17 Lynx Alternative Breaks Staff/Faculty Advisor Application CU Denver Alternative Breaks Staff Advisors Applications are due by 5pm on Sunday, September 25th. Staff/Faculty Advisor Responsibilities and Expectations: Staff/Faculty Advisors (SFAs) are an integral part of the Lynx AB program. Trip Leaders coordinate the logistics for the trip, facilitate team activities and reflections, and serve as the main contact for service sites. SFA's serve as an advisor for Trip Leaders by providing support throughout the planning process and the trip itself. SFAs also serve as a resource and mentor for participants before, during and after the trip. It is important for Staff/Faculty Advisors and Trip Leaders to proactively discuss expectations they have for each other and specific tasks to be distributed. In general however, all SFA's will be expected to: Before the Trip Meet with trip leaders on a regular basis to discuss trip-planning process and provide guidance and assistance where needed. Specific meeting expectations: Meet with the Trip Leaders twice a month in person Have virtual check-ins (over email, gchat, over phone) at least weekly with trip leaders Assist your team in fundraising efforts to offset the cost of the trip for participants Attend team meetings and service activities; assist team leaders in setting meeting agendas and objectives Attend Staff/Faculty Advisor training (Dates TBD) During the Trip Manage money for food, gas, and other expenses (in the form of a University Travel Card) Your supervisor will need to approve that you be given a Travel Card. This card will be cancel upon the approval of necessary reports (likely 1-2 months after your trip). Take appropriate actions in case of an emergency on the trip Participate in all service and reflection experiences during the trip Create deep meaningful dialogue, inquiry and critical thinking surrounding social justice issues Serve as a resource for the Trip Leaders concerning group dynamics and logistics as needed Encourage and support Trip Leaders as the primary guides, facilitators, and leaders of your AB experience After the Trip – Turn in all expense reports and receipts Complete Staff/Faculty Advisor Assessment Attend post-trip Staff/Faculty Advisor Meeting Participate in post-trip team activities and service Participate in the Lynx AB reorientation events (April) Staff/Faculty Advisor Benefits: Opportunity for personal development through participation in an extended service-learning experience Opportunity professional development through interactions with a small group of students from a variety of college departments and interest areas across campus. Staff advisors’ trip expenses (including transportation, lodging, and food) are covered in full Opportunity to share personal expertise or research interests with a group of students in a real-life setting ***Important Note: As a Staff/Faculty Advisor, the Lynx Alternative Break program will cover the expenses for your trip, however, you will need to ensure with your supervisor that you are able to take the entire period off from work.You will also need approval to be away from your position for up to 4 hours for meetings prior to the trip. For more information or with questions, please contact Megan Frewaldt, Office of Student Life Assistant Director for Community Engagement, at [email protected], 303.556.3944, or OrgSync messaging.

General Information Full Legal Name [Required] Please enter your full legal name. This information is used for the purpose of booking airline flights.

Preferred Name If this is different from your legal name.

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Employee ID [Required] Valid input: - Numeric - ex: 1111

Date of Birth [Required] This information is only used for the purpose of booking airline flights.

Cell Phone Number [Required] Valid input: - must be 10-15 digits long and may include only numbers,

hyphens, and spaces.

CU Denver Email Address [Required] Valid input: - [email protected]

Non-CU Email Address [Required] Valid input: - [email protected]

In which department or office do you work? [Required]

Are you a member of any campus organizations? If so, which ones? [Required]

T-Shirt Size [Required] Valid input: - Select only one choice. [ [ [ [ [ [

] Extra Small ] Small ] Medium ] Large ] XL ] XXL

Gender Identification [Required] Valid input: - Select only one choice. [ [ [ [ [ [

] Woman Identified ] Man Identified ] Transgender ] Genderqueer ] I prefer an alternative term ] I prefer not to answer.

Preferred Gender Pronoun [Required] Valid input: - Select only one choice. [ [ [ [ [ [ [

] He/Him/His ] She/Her/Hers ] They/Them/Theirs ] Ze/Zir/Zirs ] Xi/Xir/Xirs ] Other ] Pronouns may not seem like that big a deal, but they become a bigger deal when you try to live without them. And for some people, pronouns are a big deal because other folks don’t always use the correct pronouns to describe them. A preferred gender pronoun, or PGP, is simply the pronoun or set of pronouns that an individual would like others to use when talking to or about that individual. In English, the singular pronouns that we use most frequently are: I, you, she, her, he, him, and it. “I”, “you” and “it” are what we call “gender neutral” or “all gender”, but “she”, “her”, “he” and “him” are gendered. This can create an issue for transgender and gender nonconforming people, because others may not use the pronouns they prefer when speaking to them or about them.

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Please visit: www.gsafewi.org/wp-content/uploads/What-the-heck-is-a-PGP1.pdf for more information.

Alternative Breaks Experience Past Alternative Breaks Experience [Required] Please list which AB trips you participated in, including the years and issue area focused on.

Please Select your Trip Preferences [Required] Select your first choice trip. AWB - First to second weeks of January ASB - Spring Break in march Guatemala - Maymester break

[ ] Winter Break: Immigration in the Borderlands [Trip Leaders: Grecia Portillo & Yvette Ledezma] [ ] Winter Break: Public & Mental Health [Trip Leaders: Sanju Garimella & Erica Fraser] [ ] Winter Break: LGBTQ+ Advocacy [Trip Leaders: Juliann Richardson & Nadeen Ibrahim] [ ] Winter Break: Children with Special Needs in the Educational System [Trip Leaders: Jen Samudio & Hue Phung] [ ] Spring Break: Public Health & Social Justice in the Flint, Michigan Water Crisis [Trip Leaders: Adnan Syed & Jazmin Beltran] [ ] Spring Break: Women’s Health & Empowerment: Exploring the Roots of Gender-Based Violence [Trip Leaders: Vikasini Mahalingam & Hannah Stobaugh] [ ] Spring Break: Environmental Stewardship in the National Parks [Trip Leaders, Claire Ransom, Jessica Huynh, & Matt McCoo] [ ] Maymester: Sustainable Community Development in Guatemala [Trip Leaders: Kendra Kirby, Brittany Herrera, & Thomas Parsa] Please Select your Trip Preferences [Required] Select your SECOND choice trip. Winter Break- First to second weeks of January Spring Break - Spring Break in march Guatemala - Maymester break

[ ] Winter Break: Immigration in the Borderlands [Trip Leaders: Grecia Portillo & Yvette Ledezma] [ ] Winter Break: Public & Mental Health [Trip Leaders: Sanju Garimella & Erica Fraser] [ ] Winter Break: LGBTQ+ Advocacy [Trip Leaders: Juliann Richardson & Nadeen Ibrahim] [ ] Winter Break: Children with Special Needs in the Educational System [Trip Leaders: Jen Samudio & Hue Phung] [ ] Spring Break: Public Health & Social Justice in the Flint, Michigan Water Crisis [Trip Leaders: Adnan Syed & Jazmin Beltran] [ ] Spring Break: Women’s Health & Empowerment: Exploring the Roots of Gender-Based Violence [Trip Leaders: Vikasini Mahalingam & Hannah Stobaugh] [ ] Spring Break: Environmental Stewardship in the National Parks [Trip Leaders, Claire Ransom, Jessica Huynh, & Matt McCoo] [ ] Maymester: Sustainable Community Development in Guatemala [Trip Leaders: Kendra Kirby, Brittany Herrera, & Thomas Parsa] Please Select your Trip Preferences [Required] Select your THIRD choice trip. Winter Break- First to second weeks of January Spring Break - Spring Break in march Guatemala - Maymester break

[ ] Winter Break: Immigration in the Borderlands [Trip Leaders: Grecia Portillo & Yvette Ledezma] [ ] Winter Break: Public & Mental Health [Trip Leaders: Sanju Garimella & Erica Fraser] [ ] Winter Break: LGBTQ+ Advocacy [Trip Leaders: Juliann Richardson & Nadeen Ibrahim] [ ] Winter Break: Children with Special Needs in the Educational System [Trip Leaders: Jen Samudio & Hue Phung] [ ] Spring Break: Public Health & Social Justice in the Flint, Michigan Water Crisis [Trip Leaders: Adnan Syed & Jazmin Beltran] [ ] Spring Break: Women’s Health & Empowerment: Exploring the Roots of Gender-Based Violence [Trip Leaders: Vikasini Mahalingam & Hannah Stobaugh] [ ] Spring Break: Environmental Stewardship in the National Parks [Trip Leaders, Claire Ransom, Jessica Huynh, & Matt McCoo] [ ] Maymester: Sustainable Community Development in Guatemala [Trip Leaders: Kendra Kirby, Brittany Herrera, & Thomas Parsa] Please describe why you ranked the trip choices as you did. How do you feel you could contribute to the trip and support the Trip Leaders? [Required]

What do you believe is the purpose/vision of Lynx Alternative Breaks? [Required]

Please describe your philosophy of working with students. How will your philosophy determine the role you have with the Lynx AB Trip Leaders and participants? What unique experiences, skills, or knowledge do you have to offer students? [Required]

What social, cultural, or environmental justice issue are you most passionate about? Why? [Required]

Provide an example of when you were pushed beyond your comfort zones and how the experience impacted you. [Required]

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If you have been involved in volunteer work previously, share your motivations and your experiences. What community(ies) are you a member of, and how do you engage in that(those) community(ies)? [Required]

Share how you hope the Staff/Faculty Advisor role will contribute to your personal and professional growth. [Required]

Please describe the skills and experiences you possess that are relevant to the trip you wish to advise? [Required] I.e. leadership training, volunteer experience, first aid, camping, construction, education-related, survival skills, Spanish-speaking, group facilitation

Resume/CV [Required] Please upload a current resume.

Medical Information, Policies, & Agreements Dietary Needs & Restrictions [Required]

Allergies [Required]

Medications [Required] Over the Counter and Prescription

Physical Limitations [Required]

Do you require any accommodations for a disability? If so, please explain. [Required] The CU Denver Alternative Breaks program is committed to making AB experiences possible for all individuals and work diligently to make all reasonable accomodations possible.

Health Insurance Information [Required] Company, Phone, Group/Policy Number

Emergency Contact Information [Required] Include name, relation, phone, and email address.

Substance-Free Agreement [Required] Alcohol and illegal drugs are nationally recognized as substances, which may have a negative effect on the lives of college students and the community. As a university sponsored event that focuses primarily on civic engagement and personal growth through service, the Office of Student Life recognizes that alcohol is not needed for a good time or to promote positive growth. Illicit drugs can be lethal. Therefore, all events associated with the CU Denver Alternative Break program will be “alcohol and drug free.” This policy will be enforced by the trip leaders participating in the event. I have read and understand the above policy statement concerning the use of alcohol and other illicit drugs and/or substances and agree to adhere to the policies throughout the duration of my participation in the Alternative Break program. I am aware that failure to adhere to these policies may result in my removal from the program and will result in disciplinary action by CU Denver or referral to my college’s conduct office upon my return to campus. I further understand that my removal from the program will result in loss of all program privileges and that my registration fee will not be refunded.

Valid input: - Select only one choice. [ ] I agree to the Substance-Free Agreement. Alternative Break Staff Advisor Position Description Staff Advisor Responsibilities and Expectations: Staff Advisors are an integral part of the AB program. Trip Leaders coordinate the logistics for the trip, facilitate team activities and reflections, and serve as the main contact for service sites. Staff Advisors serve as an advisor for Trip Leaders by providing support throughout the planning process and the trip itself. Staff Advisors also serve as a resource and mentor for participants before, during and after the trip. It is important for Staff Advisors and Trip Leaders to proactively discuss expectations they have for each other and specific tasks to be distributed. In general however, all Staff Advisors will be expected to: Page 4 of 6 · 2016-17 Lynx Alternative Breaks Staff/Faculty Advisor Application

Before the Trip Meet with trip leaders on a regular basis to discuss trip-planning process and provide guidance and assistance where needed. Specific meeting expectations: Meet with the Trip Leader twice a month in person Have virtual check-ins (over email, gchat, over phone) at least weekly with trip leaders Assist your team in fundraising efforts to offset the cost of the trip for participants Attend team meetings and service activities; assist team leaders in setting meeting agendas and objectives Attend Staff Advisor training (Dates TBD) During the Trip Manage money for food, gas, and other expenses (in the form of a University Travel Card) Take appropriate actions in case of an emergency on the trip Participate in all service and reflection experiences during the trip Create deep meaningful dialogue, inquiry and critical thinking surrounding social justice issues Serve as a resource for the Trip Leaders concerning group dynamics and logistics as needed Encourage and support Trip Leaders as the primary guides, facilitators, and leaders of your AB experience After the Trip – Turn in all expense reports and receipts Complete Staff Advisor Assessment Attend post-trip Staff Advisor Meeting Participate in post-trip team activities and service Participate in the AB reorientation events (Date TBD) Staff Advisor Benefits Opportunity for personal development through participation in an extended service-learning experience Opportunity professional development through interactions with a small group of students from a variety of college departments and interest areas across campus. Staff advisors’ trip expenses (including transportation, lodging, and food) are covered in full Opportunity to share personal expertise or research interests with a group of students in a real-life setting ***Important Note: As a Staff Advisor, the Alternative Break program will cover the expenses for your trip, however, you will need to ensure with your supervisor that you are able to take the entire period off from work Staff Faculty Advisor Role & Responsibilities [Required] [ ] I agree to the Staff Advisor Responsibilities. I understand that trip attendance is dependent upon meeting the required responsibilities of the Staff Advisor. If I fail to meet the roles and expectations of the Staff Advisor role, my position may be forfeited. Financial Agreement [Required] Staff Advisors attend their respective Alternative Breaks trip free of charge. Trip attendance is dependent upon completion of all required Staff Advisor responsibilities.

Valid input: - Select only one choice. [ ] I agree to the terms.

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Liability Waiver Notice to Participants of Risk and Waiver of Responsibility Activity: Lynx Alternative Breaks Date Starting: September 25th, 2016 End: June 30th, 2017 Participant Name: Received in application. Emergency Contact Phone Numbers: Received in application. The University of Colorado welcomes you as a participant in this activity, including the use of University of Colorado facilities and equipment. Please read through the following important information. I exercise my own free and voluntary choice to participate in the designated activity, including use of facilities and equipment provided by the University of Colorado. I understand and assume all associated risks of the designated activity. I agree to assume all risk of personal injury or loss, bodily injury (including death), damage to or loss of, or destruction of any personal property resulting from or arising out of participation in the designated activity. I also release, waive, indemnify, hold harmless, and discharge the University of Colorado and CU Denver Alternative Breaks Community Partners from all claims, damages, and injuries arising out of my activities, including my use of equipment and facilities provided by the University of Colorado. I hereby grant The Regents of the University of Colorado unrestricted permission to use and re-use my name, photographic portraits, video, digital or film images, or any pictures taken of myself, individually or in conjunction with other photographs, in any printed or videographic matter, in any and all media, and for any purpose allowed by law. This includes, but is not limited to, illustration, promotion, art, editorial, advertising and trade. I hereby waive any right to inspect or approve the finished product(s) that may be used in connection with the abovementioned images. I understand that the abovementioned images and copyright privileges of the images shall be the sole property of the University of Colorado, and that I will receive no money or remuneration of any kind from The Regents of the University of Colorado. I hereby release the Regents of the University of Colorado, their legal representatives, and all people acting under their permission or authority, from any liability in connection with the use of the images as outlined above. The University of Colorado does not provide health insurance for individuals participating in activities made available or sponsored by the University of Colorado. As such, you or your personal health insurance will be responsible for payment of medical services and care for any injuries sustained during the designated activity. I hereby certify that I have read and understand the provisions above. For participants under 18 years of age, the parent or guardian accepts the above terms and grants permissions for the student’s participation on behalf of said minor, as permitted by C.R.S. § 13-22-107. Selected Box Serves as Agreement to Liability Waiver

Valid input: - Select only one choice. [ ] I have reviewed the Liability Waiver and agree to the terms.

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