Colorado Mountain Club – Denver Group

Wilderness Trekking School Instructor Application

Instructor Application and Personal Data Sheet

Session – Spring 2015 / Please submit by Tuesday, March 10, 2015.

Instructor Candidates – Please fill out this form completely. WTS needs this information to select and assign instructors, for emergency use, and for maintaining records on instructor qualifications. Please update the WTS Director whenever this information changes. All instructors must be willing to accommodate all paces and skill levels from beginner to advanced.

Please E-mail completed form to:

Senior Instructors – Dave Callais (303-237-3726),

Associate Instructors (Returning Assistants) – Ken Gurvin (720-542-6720),

Assistant Instructors (New Assistants) – Marc Borai (720-352-0894),

Session Information – Dates You Will Be Available

WTS gives preference to those instructors who can attend Orientation Night, participate during the entire group meeting on all lecture nights, and attend all field days and group hike. WTS strongly encourages participation in post-hike gatherings. Please indicate in Comments if you are interested only in being a make-up field day instructor, a substitute field day instructor, or both.

Lect 1 / Lect 2 / Lect 3 / Lect 4 / Lect 5 / D.L.T. / M & C / Snow Tr. / Survival / CMC Trip
04/07
__ / 04/14
__ / 04/28
__ / 05/12
__ / 05/19
__ / 04/16 Thu
__ / 04/23 Thu
__ / 04/30 Thu
__ / 05/14 Thu
__ / 05/28 Thu
__
04/18 Sat
__ / 04/25 Sat
__ / 05/02 Sat
__ / 05/16 Sat
__ / 05/30 Sat
__
04/19 Sun
__ / 04/26 Sun
__ / 05/03 Sun
__ / 05/17 Sun
__ / 05/31 Sun
__
Instr.
Orient. Night / M&C Study Hall / Instr.
M&C Day / Instr.
Snow Day / Instr.
Apprec Night / Make-up Days
Snow Travel / M & C / D.L.T. / Sur-vival / C.M.C. Trip
03/31 Tue
__ / 04/21 Tue
__ / 04/04 Sat
__ / 04/11 Sat
__ / 06/02 Tue
__ / 05/09 Sa
__ / 05/10 Su
__ / 06/06 Sa
__ / 06/07 Su
__ / 06/13 Sa
__

Comments ______

Personal Information

Since you will need to submit this form each session, you may want to keep an electronic copy. To update your Instructor Application each session, download the current form from the WTS web site and copy all of your Personal Information into the new form, overwriting the blanks.

Last Name / First / MI / Date
Address / City / ZIP
Home Phone / Work / Cell
E-mail Address / ______ / Age / ______
T-shirt size (XS–S–M–L–XL–XXL) ____ or I decline the instructor gift this session (add “X” to line) __
Last Name / First

Emergency Contacts and Information

Medical Conditions – Please describe any health conditions that may affect you or your group’s safety while hiking (such as asthma, epilepsy, or diabetes).
Please describe any special medications that you carry in your pack for your emergency use.
Please describe any allergies that you have to medications.

Persons to contact in case of emergency

Full Name / Relationship to you / Phone
Full Name / Relationship to you / Phone

Your Vehicle

Manufacturer / Model / Color / Year / License Plate

Your Experience and Training

WTS Instructor (list previous sessions, for example, S09, F08)
Other instructor or teaching experience (describe type & dates)
Other hiking and outdoor experience
Are you currently a CMC Trip Leader? / __ Yes __ No / Year approved
Are you First Aid certified (i.e. MOFA, WFA, Red Cross)? / Course name / Year
Most recent avalanche training / Course name / Year
Current CMC hiking classification / __ A __ B __ C __ D
I would like to teach with the following instructors, if possible (limit 2).
To broaden your skill set and share best practices, we encourage you to work with a variety of instructors.
I prefer to teach __ Thursdays __ Saturdays __ Sundays __ Either Sat or Sun
Selecting “Either Sat or Sun” will maximize your chances to be selected.
Preferences – Please understand we may not be able to accommodate your preferences.
Student hiking ability / __ 1 Very Fast __ 2 Fast __ 3 Medium __ 4 Slow __ 5 Slowest
Student Group size / __ 6-8 students __ 9-10 __ 11-14 __ Any size OK