ALTERNATIVE BREAK NEW TRIP
PROPOSAL
For Consideration for Fall Break 2016 - Submit by March 1, 2015
For Consideration for Spring Break 2017 - Submit by April , 2016
Please submit electronically to:
Laura Schwartz, Alternative Breaks Coordinator
[email protected]
801-587-9027
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CLIENT
Alternative Break New Trip Proposal
2013-2014
2013-2014
___
Applicant Info:
Name:_______________
Email:__________________
I am a:
 A Student of the University of Utah
 Staff of the University of Utah
 Faculty of the University of Utah
If this proposal is affiliated with a specific department or student group on campus, please state
which one(s):_________________________________________________________________
Site Location:
1. Selected Location of Alternative Break Trip Site:___________________________
2. Is there a University of Utah Alumni Chapter in this location? _________________
3. Round-Trip Mileage from the University of Utah to the Site Location is:__________
4. Anticipated Driving time in hours is estimated at:___________________________
5. This location is: (check all that apply)



Trip Issue:
Urban
Rural
Easily Accessible by vans. If no, please explain:
Submission Deadlines
1. What is the issue/theme of your trip? (300 words or less)
March 29, 2013
Agencies/Community
Partners:
For Consideration of FALL BREAK 2013
April 5, 2013
For Consideration of SPRING BREAK 2014
1. Please list each agency/community partner you intend to work with at the site location,
their mission statement, and what type of direct service you will be performing or what
education piece the agency will provide:
*Please note, you do not need to fill out all 3 agency listings if you intend to work with the same
organization the full week.
a. Agency 1:
i. Mission Statement:
ii. Direct Service/Educational Piece:
iii. Phone:
iv. Address:
b. Agency 2:
i. Mission Statement:
ii. Service:
iii. Phone:
iv. Address:
c.
Agency 3:
i. Mission Statement:
Alternative 2Break
New Trip Proposal
ii. Service:
iii. Phone:
iv. Address:
*Please list more as needed.
2. Will the bulk of your trip be focused on direct service? Please explain:
3. Would you include any educational components such as tours of organizations, guest
speakers, or documentary viewings? If so, please list these organizations/speakers you
would like to connect with.
Lodging:
1. What lodging will participants (12 total including site leader and staff partner) use during
the Alternative Break Trip?
2. Lodging Vendors: (* required)
a. Name of 1st Choice Lodging:
i. *Type of Lodging (ex: hostel, cabin, vacation rental, etc):___________
ii. *Cost (for all 12 participants for 5 days lodging): $_____________
iii. *Does the lodging vendor have availability during the week you are
looking to serve?_____________________
iv. Is the vendor willing to give an in-kind donation, or tax free charge?
__________________________________
b. Name of 2nd Choice Lodging:
i. *Type of Lodging (ex: hostel, cabin, vacation rental, etc):___________
ii. *Cost (for all 12 participants for 5 days lodging): $_____________
iii. *Does the lodging vendor have availability during the week you are
looking to serve?_____________________
iv. Is the vendor willing to give an in-kind donation, or tax free
charge?__________________________________
Staff & Student Leaders:
1. If a Student Proposal:

I am willing to develop and lead this trip for the first time, and participate fully
in the ASB program.
2. If a Staff/Faculty Proposal: (select all that apply)

I would like to staff partner this trip

I have a student who is interested in leading this trip.
If so, please provide the following information on the student:
Name (First Last):___________________
Email:___________________
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Your affiliation with student (ex: advisor, teacher, etc):
___________________________________________


This student is currently an enrolled student at the University of
Utah
This student plans to be an enrolled student the semester of the
trip will take place
Preliminary Budget:
1. The following pages hold a preliminary budget worksheet. Please fill out the numbers to
the best of your ability in each area of Lodging, Food, Transportation, and Miscellaneous
Expenditures. Please see below for notes on the budgeting process.
2. For questions, concerns, or clarification, please contact Laura Schwartz
([email protected])
3. Even if you are unable to calculate the total costs of each expenditure category, please
place important information such as mileage, lodging prices, and basic food per day, per
person amounts within the boxes.
Notes on the Creation of Preliminary Budget:
 Lodging: Pricing for lodging should be researched prior to submitting a new trip
proposal. Specific hostels or vacation rentals should be contacted for pricing and
possible availability.

o
Budget template shows the cost of per person, per night – ideal for hostel
lodging.
o
If it is a vacation rental or cabin rental, or other lodging that requires a “lump
sum” rental, simply input the lump sum for rental for 5 days, and ignore the per
cost per person piece.
Food Costs Standards:
o
$12 a day per person on urban trips minimum
o
$10 a day per person on camping or rural trips with shared kitchens minimum

Transportation Costs: Mileage to and from should be calculated using Mapquest, and
factored into the budget form. If you are having trouble completing the mileage
calculation, simply fill in the mileage – this will suffice for the committee.

Miscellaneous: If you trip requires any camping equipment, or additional rentals, please
price out rental with University of Utah ORP or outside company. Add these costs to the
miscellaneous section.
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Alternative Break Proposal Budget Template:
LODGING
Lodging on the Road
# of
Rooms
# People Per
Room
$ of each room
Taxes and fees
Hotel Stay
Traveling to
Destination
3
4
$0.00
(1 night)
*If your location does not require 2 days of driving to get to location, leave this blank.
Total Road
$0.00
Lodging Traveling
from Destination
3
4
$0.00
$0.00
(1 night)
*If your location does not require 2 days of driving to return from location, leave this blank.
Total Hotel
Lodging on the Road:
On-Site Lodging
# of
$ Per Person
# of days
people
Per day
Taxes and fees
Site Lodging
(Hostel)
12 $
0
5.00
$0.00
*If your lodging requires a lump sum payment, simply place that price in the “Total On-Site” Column
$0.00
$0.00
$0.00
Total On-Site
$0.00
Total Cost of Lodging for Trip:
$0.00
FOOD
# of people
$ per day/person
# of days
12
$0.00
8
Meal Expenses
*Standard allotments:
City Trips = $12.00 per day, per person minimum
Camping/Rural Trips with a shared kitchen = $10.00 per day, per person minimum
*8 day allotment accounts for a regular length trip. (Saturday – Saturday)
Closer trips can be shortened to 4-7 day. (ex: Saturday – Thursday)
Total Food costs
$
0.00
$
0.00
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TRANSPORTATION
Number of Vans
2
Miles
0
Cost per mile
$0.25
Cost of vehicle per day
$37.00
*Vans hold 6 people per van.
Total
Trans
$0.00
Number of days
8
Total Costs of Transportation
$0.00
To find total cost of Transportation

Multiple the 2 vans (x) # of miles (x )cost per mile = _________ Total Mileage Cost

Separately, Multiple the cost of vehicle per day x Number of days = $___________Total Vehicle Rental Cost

Add $______ Total Mileage Cost + $__________Total Vehicle Rental Cost = $_________ Total Cost of Trans
Miscellaneous Expenditures
Public Transportation Passes, Bus, etc:
$0.00
Parking & Tolls:
$0.00
Car Wash:
$20.00
Other (Please Specify):
$0.00
Other (Please Specify):
$0.00
Total Miscellaneous Expenditures
$20.00
*(This must be included in Miscellaneous costs)
Total Estimated Trip Costs:
$0.00
To find Total Estimated Trip Cost, Add the following:
Total Miscellaneous Expenditures:
Total Cost of Transportation:
Total Food Costs:
Total Cost of Lodging for Trip
$________
$________
$________
$________
Total Estimated Trip Cost
$________
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