Sign Up

Thank you for your interest in AFSCME Alternative Break programs. Complete the form below and click "Sign Up" to be considered for one of our three alternative break sessions around the country. Space is limited, so don't wait! Apply now.

If you are already in our system, just type your email address and click "Sign-Up" below.

Address
Home or Personal Email:*
First Name:*
Last Name:*

Address Line 1:*
Address Line 2:
City:*
State:*
Zip:*	-

Phone Number:*

Work Address
Address Line 1:
Address Line 2:
City:
State:
Zip:	-

Activities:*	What types of community, political, union or other social justice groups have you volunteered or worked with? What was your role?
College or University:*	College or University you attend
Foreign Language Fluency:	If you are fluent in any languages other than English, please list:
Expected Graduation Date:	,
Family Union Membership:	If anyone in your family has been a union member, please list the name of the family member(s) and the name of the union(s) here:
Union Member:	If you are a union member, please list the name of your union here:
School Email:*	Your email address at school:
References:*	Please list the names of two references with address, telephone, and how you know them.
Future plans:*	What would you like to do when you graduate?
Referrer:	How did you hear about Union Alternative Break?
Experiences:*	What experiences in your own life make you want to work for social justice and participate in AFSCME's Alternative Break program?
Your background:*	AFSCME's Alternative Break program will be an intense week with long and irregular hours working with a diverse group of students. Have you ever gone through such an experience? If yes, please explain.
Preferred Session:*	Please select the session you'd prefer to attend:
Major:*	What is your major?
*Required Field