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Application

First Name:

Last Name:

Banner ID:

Home Address:

City, State, Zip:

, ,

Email:

Including this coming trip, how many service trips have you participated in?:

Campus Address:

Phone:

Major:

Graduation Year:

Full cost of your trip:

Amount of grant money being requested:

Name of service trip:

State:

Country:

Beginning date of trip:

Ending date of trip:

If serving in a non-Villanova sponsored endeavor, please give contact name and phone number of the person with whom you will be working.

Sponsor Name:

Sponsor Phone:

Name and Phone number of your Villanova Student Leader for this trip.

Name:

Phone:

Break down the costs that are involved with your trip (e.g., transportation, room, etc.):

Other means you are pursuing to raise money for your volunteer experience:

Knowing that the Memorial Fund's resources are limited, can you assure us that you honestly have a need for financial assistance from the Fr. Ray Jackson Memorial Fund in order to be able to go on this trip?:

Yes No

Please explain your need for assistance:

Have you ever received an award from this fund in the past?:

Yes No

Essays

Please describe the work you will be doing:

Who will benefit from your work? Please describe how:

Explain how your service will exemplify the Mission of Villanova University. See Mission:

I have read the application criteria and requirements. I understand that there will be a 1,500 word reflection paper due no later than two weeks after the service experience has ended. I understand that my responses to essays may be used for publication purposes at a later date.

I agree to these terms.

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