EmailMe Form - Alternative Winter Break South Africa: Application

Name *
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Quinnipiac Email *
Please use your Quinnipiac University email address.

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Date of Birth *
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Gender *
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Academic Level (as of Fall 2013) *
Sophomore
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Major(s) *
Minors(s) *
Cumulative GPA *
Questions
Why are you interested taking part in this Alternative Winter Break Trip to South Africa? *
What type of extra curricular organizations, greek life, sports teams, etc. are you involved in on campus? *
In what ways have you given back to a community through service? *
Reference #1
Please provide two references.
(Preferably from Quinnipiac)
Name (Reference #1) *
First Last
Email (Reference #1) *
Phone (Reference #1) *
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Reference #2
Please provide two references.
(Preferably from Quinnipiac)
Name (Reference #2) *
First Last
Email (Reference #2) *
Phone (Reference #2) *
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