Alternative Spring Break Application

First Name *

Last Name *

Cell Phone Number

Sex *

Male

Female

Prefer not to answer at this time

MCC Email *

Have you done community service in the past? *

Yes

No

Are you able to travel out of state the week of April 17th - April 23rd? *

Yes

No

Note Sure Yet

You're locked in a room and forced to listen to one song, on repeat, 24 hours a day... What song do you choose? *

(List the song and artist/group)