nuSERVES 2012 First-Year Team Member Application
	Before completing this application please make sure that you reviewed the program information and sample schedule for nuSERVES 2012 located on the Center of Community Service website (www.northeastern.edu/communityservice). Please note you must complete this application at one-time, you cannot save and return to complete.
	NAME
	NU ID
	Home Address
	Home Phone
	Cell Phone
	E-mail Address
	Birthdate (MM/DD/YY)
	Gender	Male Female
	T-shirt Size:	Small Medium Large X-Large XX-Large
	Dietary Needs or Concerns
	Allergies or other Health Concerns
	Other Concerns or Special Accomodations
	Emergency Contact Name
	Relationship to You
	Primary Phone Number
	Alternate Phone Number
	E-mail Address
	Please complete short answer essay questions in 500 words or less.
	Please describe your interest in applying to be a member of nuSERVES 2012.
	Team work is essential to the nuSERVES program. Please provide an example of when you were involved in a team setting and lessons learned from that experience.
	If you could create a community service super hero, what powers would s/he use to change the world?
	Provide a summary of volunteer and/or relevant high school extra-curricular activities.
	By pressing submit, I certify that the information provided herein is true and my own. I certify that I am an incoming first-year student to Northeastern University entering fall 2012. I have read and understand the nuSERVES program fee payment and refund requirements and program information for nuSERVES 2012. I understand that I must attend or have attended a NU Summer Orientation session to be eligible for participation. I understand that students in the Honors Program are not eligible due to the conflict with Honors Welcome Week (Honors students will have the opportunity to participate in the Honors Outreach Project). I agree not to schedule or plan any programs or events during the week of nuSERVES, Monday, August 27 - Friday, August 31, 2012.