AW: Be a Participant

First Name:

Last Name:

UM ID Number: *if applicable

Uniqname: *if applicable

Email Address:

Phone Number:

Campus/Local Address:

Please select your title: -- Undergraduate - Freshmen Undergraduate - Sophomore Undergraduate - Junior Undergraduate - Senior Graduate Student Faculty Staff Community

College: -- Literature, Science, and the Arts Architecture & Urban Planning Art & Design Business Dentistry Education Engineering Information Kinesiology Law Medicine Music, Theatre & Dance Natural Resources & Environment Nursing Pharmacy Public Health Public Policy Rackham School of Graduate Studies Social Work

Concentration: -- Other Undecided Afroamerican & African Studies American Culture Anthropology Evolutionary Anthropology Asian Studies Astronomy & Astrophysics Biology General Biology Biophysics Biological Chemistry Chemistry Classical Archaeology Classical Civilization Classical Languages & Literatures Ancient Greek Language & Literature Latin Language & Literature Modern Greek Studies Communication Studies Comparative Literature Computer Science Plant Biology Ecology & Evolutionary Biology Economics Geological Sciences Earth Sciences Earth Systems Science Environmental Geosciences Oceanography German History History of Art Individual Concentration Program Informatics Judaic Studies Latin American & Caribbean Studies Latina/o Studies Linguistics Mathematics Microbiology Middle Eastern & North African Studies Cell and Molecular Biology Music Theatre & Drama Ancient Civilizations & Biblical Studies Arabic, Armenian, Persian, Turkish & Islamic Hebrew & Jewish Cultural Studies Near Eastern Civilizations Neuroscience Organizational Studies Philosophy Physics Interdisciplinary Physics Political Science Psychology Brain, Behavior, and Cognitive Sciences Arts and Ideas in the Humanities Creative Writing and Literature Drama Social Science RC Individual Concentration Program French and Francophone Studies Italian Romance Languages and Literatures Spanish Screen Arts and Cultures Russian Polish Sociology Social Anthropology Statistics Women's Studies

1. Have you applied to SERVE's AW before?
   

2. Have you participated in a SERVE's AW before?

   Yes

   No

   
   

   If yes, where?
   

3. Do you have allergies or other medical limitations that may affect choice of site? If so, please list.
   

4. How did you find out about AW?
   

5. Please rank the following issues in terms of interest, 1 being very strong interest, 6 being minimal interest:

   - 1 2 3 4 5 6 Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ)
   - 1 2 3 4 5 6 Domestic Violence
   - 1 2 3 4 5 6 Urban Renewal
   - 1 2 3 4 5 6 Homelessness
   - 1 2 3 4 5 6 Environment
   - 1 2 3 4 5 6 Disabilities
   - 1 2 3 4 5 6 Urban Poverty
   - 1 2 3 4 5 6 Collaborative Site (MCSP)

6. Write a statement of motivation in which you discuss your interests in the issues you have chosen. This may include, for example, why you want to be a part of the AW program, your experiences with community service, and why you think service is important. Please limit your response to one paragraph (approx. 10 lines).