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EKU Eastern Kentucky University Admissions

Faculty/Staff Learning Partner Interest Form

Your answers below are used by our student trip leaders and staff to catch a glimpse of who you are.

They will use this information to determine whether or not to request an interview with you.

Please be candid in your application to aid the students in making their decision.

***Only open to salaried faculty, staff, or graduate assistants with supervisor approval.***

First Name:

Last Name:

Email Address:

EKU ID Number:

Phone Number:

I am interested in serving as a learning partner for:
Alternative Spring Break
Fall Service Trip
Winter Service Trip

I am interested in trips focusing on the following areas:
Disaster Relief
Environmental Stewardship
Historic Preservation
Homelessness
Housing
No preference

Tell us a little about yourself:

Why do you want to participate as a Learning Partner on an Alternative Break:

Tell us about your service experience or why you want to become involved with service:

Have you previously participated in an alternative break? If so, when and where?:

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