Applicant Name: Date:

AICS Alaska Crossings

Previous Experience Report

How to complete this application:

Please submit applications electronically. List trips chronologically from most recent to least recent. Do not let form size limit the information you provide. Increase the number of rows as needed.

Youth Work Skills
Describe the clientele and behaviors that you have experienced and provide examples of clientele i.e. Students, Campers, At Risk Youth. Indicate if there were any therapeutic interventions and/or behavior modifications involved in the work. Please categorize experiences based on whether they were less than 5 day stints (such as working at a school) or more than 5 day stints (such as an expedition). Be sure to include any common diagnoses you saw when working with youth.

Water Experience: Ocean, Moving Water and Lake
List all paddling experiences categorized by the type of water it was on. Within each category please specify what type of craft was used as well as whether it was less than 5 days or more than 5 days. Any instructional/training courses you participated in will go in the certifications/professional development section.

Hiking Skills
List all experience you have hiking in any environment and specify whether it is on or off trail. This does not include resort skiing/snowboarding. Any instructional/training courses you participated in will go in the certifications/professional development section.

Certifications
Please list all certifications with expiration dates as well as any instructional/training courses taken in relation to the skills inquired about above. Also include any additional seminars and conferences that are related to wilderness therapy, outdoor experiences, experiential learning, etc. Please include any certifications that may have expired so we can see the depth of your experience and training throughout your tripping career.

AICS Alaska Crossings Therapeutic Behavioral Health Clinical Associates must hold a current Wilderness First Responder (WFR) certification. Copies must be obtained for personnel files prior to employment.

Please be aware that we reserve the right to confirm any experiences that you list on this application.

YOUTH WORK SKILLS
Start/End Date of program or job / Organization / Clientele (Please include age range of youth and typical clinical diagnoses you saw) / Less than 5 days: responsibilities / More than 5 days: responsibilities
Total Number of Days Worked
Water Experience: Ocean
What type of paddle do you use when on the ocean?
Craft / Location / Structure: Were you the leader of the group, member of the group or solo? / Brief Trip explanation
I.E. Class or Grade
I.E. Backcountry or Front Country / Number of Days and Date
Less than 5 days and Date / More than 5 days and Date
Grand Total Water Experience: Ocean days
Water Experience: Moving Water
What type of paddle do you use when on moving water?
Craft / Location / Structure: Were you the leader of the group, member of the group or tripping solo? / Brief Trip explanation
I.E. Class or Grade
I.E. Backcountry or Front Country / Number of Days and Date
Less than 5 days and Date / More than 5 days and Date
Grand Total Water Experience: Moving Water days
Water Experience: Lake
What type of paddle do you use when on a lake?
Craft / Location / Structure: Were you the leader of the group, member of the group or tripping solo? / Brief Trip explanation
I.E. Class or Grade
I.E. Backcountry or Front Country / Number of Days and Date
Less than 5 days and Date / More than 5 days and Date
Grand Total Water Experience: Lake days
Hiking Skills
Trip location, type of navigation used, and average weight of your pack / Season / Terrain / On/Off Trail? / Structure: Were you the leader of the group, member of the group or tripping solo? / Duration including date
Total Number of Hiking Days
Certifications, Conferences, and Professional Development
Organization, Course Name and Date Acquired / Skills acquired and certification received / Date of Expiration