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Full Name (As printed on license or passport)

Babson Email Address

Class Year

2010
2011
2012
2013

Affiliation

Undergraduate Student
Graduate Student

Campus Address

Home Address

Cell Phone Number

What is your current involvement with Habitat for Humanity?

Babson Chapter Member
Other Chapter Member
None

Trip Preference

	1
Thibodaux, LA (January 10-16th 2010)

Why would you like to participate in a Habitat for Humanity alternative spring break trip?

What would you like to get out of this experience?

I understand that If my application is accepted an interview will be schedule sometime between September 21st and October 9th 2009.

Yes
No

I understand that if accepted to a trip I will be required to make a $250 dollar deposit no later than October 16th 2009 or I will not be able to participate in the trip. I also understand that deposits are non-refundable because they will be applied to airfare immediately.

Yes
No

I understand that I will have a monthly payment plan of $250 dollars per month that can be paid outright or fundraised. Each payment will be due on the 15th of each month.

Yes
No

I understand that the total cost of the Thibodaux trip is $750 dollars.

Yes
No

Electronic Signature X