APPLICATION FOR INTERNATIONAL EXPEDITIONS Program PROGRAM YOU ARE APPLYING FOR: PROGRAM START DATE: PERSONAL CONTACT INFORMATION Last Name First Name Date of Birth Sex or Gender Height Weight Address City State/Province Zip Passport Number Phone Email EMERGENCY CONTACT INFORMATION Last Name First Name Address City State/Province Zip Phone Email Relationship EDUCATION AND WORK BACKGROUND Current or Last School Attended Highest degree, diploma or certification attained Current Employer Position Previous Employer Position PERSONAL OUTDOOR EXPERIENCE PLEASE DESCRIBE YOUR BACKPACKING EXPERIENCE. CONSIDER DESCRIBING FACTORS SUCH AS: LOCATIONS, HOW MANY DAYS, HOW MANY MILES, ELEVATION GAIN/ LOSS, TIME OF YEAR, ADVERSE CONDITIONS YOU FACED, INTERNATIONAL BACKPACKING EXPERIENCE, ETC. DO YOUR BEST TO PAINT US A PICTURE OF YOUR NON-TECHNICAL EXPERIENCE. CLIMBING AND MOUNTAINEERING/SKI MOUNTAINEERING EXPERIENCE. CONSIDER DESCRIBING FACTORS SUCH AS WHERE YOU'VE CLIMBED, LENGTH OF THE ROUTES, STEEPNESS (IN DEGREES) OF THE SNOW OR ICE, DIFFICULTY OF THE ROCK, LEADING AND/OR TOP ROPE EXPERIENCE, ELEVATION AND CONDITIONS YOU'VE CLIMBED IN, ETC. DO YOUR BEST TO PAINT US A PICTURE OF YOUR TECHNICAL EXPERIENCE. WHY ARE YOU INTERESTED IN JOINING THIS EXPEDITION? PLEASE DESCRIBE YOUR CURRENT EXERCISE ROUTINE PLEASE DESCRIBE HOW YOU PLAN TO PHYSICALLY PREPARE YOURSELF FOR THIS EXPEDITION IF YOU CURRENTLY DO NOT MEET THE PREREQUISITES FOR THIS COURSE, PLEASE EXPLAIN WHY YOU FEEL THAT YOU WILL BE A SUCCESSFUL, CONTRIBUTING MEMBER OF THIS EXPEDITION AND WHY YOU WILL NOT HOLD BACK THE TEAM MEMBERS THAT MEET THE PREREQUISITES. IF YOU HAVE A PLAN ON HOW YOU WILL MEET THE PREREQUISITES BEFORE THE COURSE, PLEASE ELABORATE HERE. IF YOU MEET THE PREREQUISITES, LEAVE THIS SECTION BLANK. PLEASE ANSWER ANY *ONE* OF THE FOLLOWING QUESTIONS: A) WHAT WAS ONE OF YOUR GREATEST ACCOMPLISHMENTS AND WHY DID IT MEAN SO MUCH TO YOU? B) HOW HAVE YOU DEALT WITH ONE OF YOUR GREATEST CHALLENGES? C) WHAT WAS ONE OF YOUR MOST REWARDING EXPERIENCES AS A LEADER AND WHY? DO YOU PLAN TO TAKE THIS COURSE FOR COLLEGE CREDIT? HOW DID YOU HEAR ABOUT SIET? BY TYPING MY NAME BELOW, I CERTIFY THAT I HAVE ANSWERED THE ABOVE QUESTIONS HONESTLY AND TO THE BEST OF MY ABILITY. I ACKNOWLEDGE THE FACT THAT IF I MISREPRESENT MY ABILITIES, PRIOR EXPERIENCE, TECHNICAL COMPETENCE OR IN ANY OTHER WAY EMBELLISH THE TRUTH ON THIS APPLICATION I MAY BE REQUIRED TO LEAVE THE EXPEDITION AT MY OWN EXPENSE AND WITHOUT A REFUND IF THE INSTRUCTOR(S) FEEL THAT I AM NOT PREPARED TO MAINTAIN A LEVEL OF ADEQUATE RISK MANAGEMENT AND DEMONSTRATE A LEVEL OF COMPETENCY THAT BENEFITS THE EXPEDITION AND ITS MEMBERS. I HAVE READ THE APPROPRIATE PREREQUISITES ON THIS WEBSITE AND I AM CONFIDENT THAT I MEET OR EXCEED ALL OF THE SKILLS LISTED. IF I DO NOT MEET THE PREREQUISITES, I MADE THIS CLEAR ON THE APPLICATION AND I HAVE EXPLAINED WHY I SHOULD BE EXEMPT FROM SPECIFIC PREREQUISITES. IF I DO NOT MEET THE PREREQUISITES, I UNDERSTAND THAT I CANNOT PAY A DEPOSIT ON ANY PROGRAM AND WILL NOT BE ABLE TO JOIN AN EXPEDITION UNTIL I RECEIVE A LETTER FROM THE DIRECTOR OF SIET INDICATING THAT I CAN DO SO. Full Legal Name Date CAPTCHA * + three = nine Please call with any questions: 760-920-3464 Δ
