OUTDOOR PROGRAM TRIP LEADER APPLICATION
This application is a required tool that will be used to select leaders for all trips of 2 or more days in length.  Everyone interested in leading trips must have an application on file so it is possible for the OP to make appropriate leader selections.

Please be as specific as possible with your responses.

Date of Application ________________	

Name ___________________________________________ Phone  	(           )__________________ (home)
									(           )__________________ (other)

Current Address _________________________________ City ____________ State _____ Zip _______

e-mail Address ___________________________	Student I.D. # _______________________

Driver’s License number ____________________	State of Issue ____________	Date of Birth  ______

CERTIFICATION/LICENSURE:
First Aid Certifications (include CPR, First Aid (include level), EMT, etc.)
	• Type of Certification ___________________________________ Valid Until ________________
	• Type of Certification ___________________________________ Valid Until ________________
	• Type of Certification ___________________________________ Valid Until ________________

Professional Certifications and Licensure - include lifesaving, teaching licensure, skills instruction, etc. 
	• Type of Certification ___________________________________  Valid Until _______________
		Organization Affiliated with ______________________________________________
	• Type of Certification ___________________________________ Valid Until ________________
		Organization Affiliated with ______________________________________________
	• Type of Certification ___________________________________ Valid Until ________________
		Organization Affiliated with ______________________________________________
	• Type of Certification ___________________________________ Valid Until ________________
		Organization Affiliated with ______________________________________________

Type of Driver’s License (Class A, B, C, Commercial Endorsment, etc) _______________________________

SKILLS  - rate yourself from 1 to 5 where “1” is weak, “5” is expert (we want to know what you are good at):
_____	Canoeing	_____	Carpentry		_____	X-C Skiing		_____	Birding 
_____	Kayaking	_____	Wtr. Camping		_____	Photography		_____	Nat. History
_____	Rafting		_____	Group dynamics	_____	Lesson planning	Working with: 
_____	First Aid	_____	Rock Climbing		_____	Survival Skills		_____	Adults
_____	Leadership	_____	Backpacking		_____	Snowshoeing		_____	Children
• Why do you feel confident in your highest ranked skill areas?

QUESTIONS (attach on a separate page):
•  What makes you a good trip leader?
•  What skills would you like to improve?
•  What was one of your most difficult teaching experiences and how did you handle it?
•  What teaching methods or leadership techniques do you use to work effectively with participants?
•  Why do you believe Outdoor Education is valuable?

OTHER ITEMS TO ATTACH:
1). 	RESUME -  includes: education, experience, & references
2). 	TRIP LOG -  you can use the OP form or your own system
3). 	TRIP LEADER QUALIFICATIONS AND SCHEDULE-  indicates the trips you would like to lead by filling in the box  that matches your level of experience with several trip options.