Civic Engagement

2011-2012 Service Trip Registration

Please Note: All fields with an * are required.

* Trip Please select an item.
* Campus Please select an item.
* First Name: A value is required.
* Last Name A value is required.
* NSU ID A value is required.
* NSU E-mail A value is required.Invalid format.
* Cell Phone # A value is required.Invalid format.
* Class Standing Please select an item.
* Allergies
(If no allegeries, type "none")		 A value is required.
* Current Medication
(If no medication, type "none")		 A value is required.
* T-Shirt Size Please select an item.

First Emergency Contact Info


* First Name: A value is required.
* Last Name A value is required.
* Relation to Student A value is required.
* Address A value is required.
* Home Phone # A value is required.Invalid format.
* Work Phone # A value is required.Invalid format.

Second Emergency Contact Info


* First Name: A value is required.
* Last Name A value is required.
* Relation to Student A value is required.
* Address A value is required.
* Home Phone # A value is required.Invalid format.
* Work Phone # A value is required.Invalid format.

* Have you previously volunteered on a Student Leadership
and Civic Engagement/CAUSE Service Trip?
* Briefly describe your previous service involvement.

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* Based on the trip that you are applying for,
what is your knowledge of the location we will be working in?

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* Briefly describe your motivation for participating in a service trip.

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* What can you contribute to this service trip?

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* Briefly describe your expectations and/or goals if selected for this service trip.

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* How would you share your trip experiences when you return?

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NSU Service Trip Participant/Financial Agreement Form

  • Abide by all rules and regulations outlined in NSU's Code of Conduct
  • Be on time to all Service Trip Appointments (this includes meetings, payment dates, fundraising events, travel departures, work schedules and curfews while on the trip)
  • All payments for service trips must be in by 5pm on the appointed deadline
  • REFUND POLICY IS AS FOLLOWS:
    • Airfare is NON-REFUNDABLE
    • All other payments will be refunded on a case by case basis
  • Treat all participants, non-profit staff and volunteers, along with community members with respect
  • Nova Southeastern University does not encourage or endorse the possession or consumption of illegal substances or alcohol; for clarification all service trips are illegal substance AND alcohol free regardless of age.
  • I will not leave the service site location without notification and permission of NSU staff.
  • Chaperones and/or NSU staff reserve the right to remove me from the service trip at any time. If removed from the trip, I will pay for my travel back to Fort Lauderdale, FL.
  • The first set number of students to complete this form and submit the required payments, reserve the right to attend. Failure to submit forms and necessary payments in compliance with the attached checklist will forfeit their reservation on this trip.

Agree to this term:

By checking this box, I have read and agree to the above expectations.
* Full Name A value is required.
* NSU ID A value is required.