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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.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Name of Survey Researcher] at [Phone Number] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
Instructor Contact Info
 
 
* First Name : 
* Last Name : 
* Address 1 : 
   Address 2 : 
* City : 
* State : 
* Zip : 
* Phone : 
* Email Address : 
 
 
Certifications/Experience
 
 
PSIA/AASI, CSIA
 
 
Second Discipline
 
 
 
Third Discipline
 
 
 
Children's Specialist
 
 
 
Freestyle Specialist
 
 
 
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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