Mini Mountain Instructor, Clinic Leader and Coaching Application
Please designate what position or positions you are applying for from this list:
Ski Instructor
Snowboard Instructor
Ski/Snowboard Instructor
Ski Clinic Leader/Instructor
Snowboard Clinic Leader/Instructor
Instructor Assistant
Race Coach or Assistant Coach
Social Security Number
First Name
Last Name
Address
City
US States
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennesse
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Guam
Puerto Rico
US Virgin Islands
Armed Forces Africas
Armed Forces Americas
Armed Forces Canada
Armed Forces Europe
Armed Forces Middle East
Armed Forces Pacific
Zip
Email
Fax Number
Phone Number
Mobil Phone Number
Age
How many years have you taught for Mini Mountain
Never
1
2
3
4
5+
Are you planing to attend Mt Hood Clinic Aug 18th and 19th?
Yes
No
Are you interested in car pooling to Mt Hood?
Yes
No
How many years have you taught skiing?
None
1-3
4-6
7+
How many years have you taught snowboarding?
None
1-3
4-6
7+
What level PSIA member are you?
Not a Member
Registered
1
2
3
How many years have you taught ski clinics?
Never
1-2
3-5
6+
How many years have you taught snowboard clinics?
Never
1-2
3-5
6+
Years of experiance coaching ski racing
None
1-3
4-7
8+
Please add any other applicable experience. For instance, other ski schools you have taught for, or experience with teaching children, etc.
Please check the programs and times you are available to teach or clinic.
Monday Program
January 7¸14¸28 February 4¸11¸25 Time 3:30-6:00PM
Wednesday runs January 9,16,23,30 February 6,13
1:30-4:00
2:00-4:30
2:30-5:00
3:00-5:30
Thursday Program
January 3-24 February 14-28 March 6 5:00pm-7:00pm
Friday Programs
6 Week January 4-25 February 1-8 5:00PM-6:30PM
8 Weeks January 4-25 February 8-29 7:00PM-9:00PM
Saturday Program
Runs 8 weeks January 5,12,19,26 February 9,16,23 March 1
10:00-12:00
1:00-3:00
Sunday Program
Runs 8 weeks January 6,13,20,27 Feburary10,17,24 March 2
10:00-12:00
1:00-3:00
Applicant Disclosure Form
Answer yes or no to these items. If the answer is yes to any of these items explain in the area below
Have you ever been convicted of any crimes against persons as defined in Section 1 of Chapter 486 Laws of 1987.
Yes
No
Have you ever been found in any dependency action under RCW 13.34.030(2)(b) to have sexually assaulted or physically abused any minor. Or under Title 26 RCW to have sexually abused or exploited any minor.
Yes
No