NSP EDUCATION PROGRAMS

INSTRUCTOR APPLICATION

Personal Data
Name / NSP ID #
Address / Phone (Home)
City State Zip / Phone (Work)
Email address / Name of Patrol
Division / Region
Instructor Education Discipline
(Submit an application for each discipline being applied for)
Instructor Development / Nordic Toboggan / Mountain Travel and Rescue
Outdoor Emergency Care / Patroller Enrichment Seminar / Level I Avalanche
Alpine Toboggan / Other / Level II Avalanche
Initial Instructor Training and Prerequisites / Instructor/Mentor/IT
(Please print name) / Completion Date / Location
Instructor Development Course
Mentor Assigned
IT Evaluation Completed
Instructor Status Granted
Instructor Experience—Discipline / Year(s):
Notes:

Region advisor and Division supervisor keep copies of instructor application. Division supervisor submitsCourse Completion Recordto National Office for instructor data entry and generation of instructor cards.

Education Department

National Ski Patrol

133 South Van Gordon Street, Suite 100

Lakewood, CO 80228

FAX 1-800-222-4754 or 303-988-1111

Level 1 Avalanche Instructor – required prerequisite courses (complete the following section)
Instructor Development / Instructor of Record:
NSP#: / Date: / Course Completion #:
Level 1 Avalanche for Rescue Personnel / Instructor of Record:
NSP#: / Date: / Course Completion #:
Level 2 Avalanche for Rescue Personnel / Instructor of Record:
NSP#: / Date: / Course Completion #:
Course within three previous years
(are you current?) / Instructor of Record:
NSP#: / Date: / Course Completion #:
Prospective Level 1 Avalanche Instructor has the following current versions of avalanche course material(s)
NSP Avalanche Instructor Manual, 2008 or current edition / Yes: / No: / Edition:
NSP Avalanche Rescue Fundamentals, 2nd Ed, 2010 / Yes: / No: / Edition:
NSP Avalanche Rescue Quick Guide, 2009 / Yes: / No: / Edition:
NSP Backcountry Avalanche Safety, 2010 / Yes: / No: / Edition:
Snow Sense, Revised 1999 / Yes: / No: / Edition:
Staying Alive in Avalanche Terrain, 2nd Ed, 2010 / Edition:
Snow, Weather, and Avalanche Guidelines, (SWAG) 2010 / Edition:
Other materials: (list)
• / • / •
A snow study field book / Yes: / No:
Snow study kit / Yes: / No:
Avalanche Beacon (currently sold model) – Brand Model / Yes: / No:
Probe / Yes: / No:
Shovel / Yes: / No:
Optional other training and resources
National Avalanche School – Phase 1 classroom / Yes: / No: / Date:
National Avalanche School – Phase 2 field / Yes: / No: / Date:
International Snow Science Workshop / Yes: / No: / Date:
Other avalanche courses, non-NSP / Yes: / No: / Date:
American Avalanche Association member (receive The Avalanche Review) / Yes: / No: / Date:
Level 2 Avalanche Instructor – required prerequisite courses (complete the following section)
Prospective Level 2 Instructor has all of the above avalanche course materials (current versions) / Yes: / No:
Prospective Level 2 Instructor has required teaching experience / Yes: / No:
Instructor Activity Log is attached / Yes: / No:
Prospective Level 2 Instructor has been Instructor-of-Record (IOR) for Level 1 Avalanche for Rescue Personnel course / Yes: / No:
Prospective Level 2 Instructor has instructed a minimum of two Level 2 Avalanche for Rescue Personnel courses / Yes: / No:

2011/12 Avalanche Instructor Application Form – Oregon Region. Modified from Far West Division (c/o Frank Rossi)Page 1