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2013
September
I
Instructor Points Survey
Instructor Points Survey
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Hello Everyone:
You are invited to participate in our survey [Project Description Here]. In this survey, approximately [Approximate Respondents] people will be asked to complete a survey that asks questions about [General Survey Process]. It will take approximately [Approximate Time] minutes to complete the questionnaire.
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Instructor Contact Info
*
First Name
:
*
Last Name
:
*
Address 1
:
Address 2
:
*
City
:
*
State
:
*
Zip
:
*
Phone
:
*
Email Address
:
Certifications/Experience
PSIA/AASI, CSIA
-- Select --
Level One
Level Two
Level Three
Second Discipline
-- Select --
Level One
Level Two
Level Three
Third Discipline
-- Select --
Level One
Level Two
Level Three
Children's Specialist
-- Select --
Level One
Level Two
Freestyle Specialist
-- Select --
Level One
Level Two
Level Three
Please check all boxes that apply.
(Example: If you have a Level 3 be sure to also check the Level 1 and Level 2 boxes.)
Level 1 PSIA/AASI, CSIA
Level 2 PSIA/AASI, CSIA
Level 3 PSIA/AASI, CSIA
Level 1 in Secnd Discipline
Level 2 in Secnd Discipline
Level 3 in Secnd Discipline
Level 1 in Third Discipline
Level 2 in Third Discipline
Level 3 in Third Discipline
PSIA Master Teacher
Children's Specialist 1
Children's Specialist 2
Freestyle Specialist 1
Freestyle Specialist 2
Freestyle Specialist 3
Backountry Accreditation
PSIA/AASI Educational Staff
PSIA/AASI, CSIA Examiner
PSIA/AASI Divisional Team
PSIA/AASI National Team
USASA Technical Supervisor 1
USASA Technical Supervisor 2
USASA Technical Supervisor 3
USASA Coach 100
USASA Coach 200
USASA Coach 300
Board member of outside organization
Outdoor Emergency Care / WFR
Ski Patrol Certification
Wilderness First Aid
Bachelor's Degree in Related Field
Master's Degree in Related Field
Doctorate in Related Field
Promoted to Lead Position
Promoted to a Supervisor Position
Overseeing a specific program
Other
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