Service-Immersion Trip Application

Please indicate your 1st, 2nd, 3rd, 4th, 5th, 6th & 7th choice. Only number trips in which you are intested - if you are not interested in a particular trip, leave it blank.
Ranking
Location
Service
Dates
Christmas Break
Philadelphia, PA
Homeless Outreach, Urban Elementary School
Sat, Jan 2 - Sat, Jan 9
Chinandega, Nicaragua
Construction, bringing Running Water to Remote Villages
Sat, Jan 2 - Sat, Jan 9
Spring Break
San Lucas, Guatemala
Coffee Project, Garden, Construction
Sat, Mar 12 - Sat, Mar 19
Diocese of Mandeville, Jamaica
Schools, clinics and housing projects in rural Jamaica
Sat, Mar 12 - Sat, Mar 19
Chinandega, Nicaragua
Construction, bringing Running Water to Remote Villages
Sat, Mar 12 - Sat, Mar 19
West Virginia
Community Garden, Clothes Closet, Learn about Environmental Issues
Sun, Mar 13 - Sat, Mar 19
Santiago, Dominican Republic
Construction, Coffee Planting, Stay with Host Families
Sat, Mar 12 - Sat, Mar 19

Several partial scholarships for service-immersion participants are available. These scholarships are made available through the generosity of Cody Shuler, a 2014 Rockhurst University graduate and a participant in the 2013 Rockhurst University Nicaragua service-immersion trip. Cody died of cancer on Nov. 25, 2014. Friends and family honor his memory and his passion for service by offering partial scholarships, one for an international trip and one for a domestic trip. If you would like to be considered for one of these scholarships, please email Bill.Kriege@rockhurst.edu. Please note:
  • Only students with significant financial need will be considered
  • All applicants will have their Rockhurst University financial aid records checked to verify financial need.
FERPA RELEASE FOR DISCLOSURE OF STUDENT EDUCATION RECORDS FORM

Pursuant to the Family Education Rights and Privacy Act (“FERPA”), I hereby authorize Rockhurst University and its employees and/or agents to disclose the student education records described below to the persons or entities named below for the purpose stated below.

All Records, including:

  • Academic Transcript (e.g., Grades/GPA)
  • Service Transcript
  • Financial Aid Records
  • Employment Records
  • Student Conduct Records
  • Athletic Records
  • Student Account Records
  • Medical Records

This information will be sent/shared with:

  • Rockhurst University faculty/staff
  • Service-Immersion partner agencies

For the purpose of evaluating your application to:

  • Rockhurst University service-immersion trips

I understand that this consent (and any waiver as relating to a letter of recommendation) shall remain in effect unless revoked by me in writing. Revocation will not affect disclosures previously made prior to receipt of the written revocation.

THE INFORMATION CONTEMPLATED IN THIS FORM IS RELEASED SUBJECT TO THE CONFIDENTIALITY PROVISIONS OF FERPA AND OTHER APPROPRIATE STATE AND FEDERAL LAWS AND REGULATIONS, WHICH PROHIBIT ANY FURTHER DISCLOSURE OF THIS INFORMATION WITHOUT THE SPECIFIC WRITTEN CONSENT OF THE PERSON TO WHOM IT PERTAINS, EXCEPT AS OTHERWISE PERMITTED BY SUCH REGULATIONS.

Application Deadline - October 2, 2015 @ 4:00 p.m.
Please sign up for an interview time with Susan Janet, Massman 1
(Interviews will be conducted Mon, Oct 12 - Fri, Oct 16)