Anake Outdoor School Application | Wilderness Awareness School

Applicant (legal name):

*Last:

*First: Middle:

*SS#:

- - (As required by Washington state law)

Gender:

*Date of birth:

//

Citizen of:

*

*Highest Grade Completed:

Graduation DateDate GED Attained: / / Name of Certificate: Major:

Last School Attended:

*Name:

*Street:

*City:

State:

*ZIP:

Current/Most Recent Employer:

*Name:

*Street:

*City:

State:

*ZIP:

Do you have any medical, physical, or psychological condition which may influence your ability, or may require special adaptation, to complete your training in the program? Please take your time and answer as honestly as possible so that we may work together to the best of our abilities.

I have previously applied for admission to the Anake Outdoor School (previously the Residential Program).

I am planning to apply for college credit for this program.

Contact Information

Mailing Address

*Street:

Apt:

*City:

State:

*ZIP:

Address Valid

*//

Permanent Address: ( Same as above)

*Street:

Apt:

*City:

State:

*ZIP:

Other contact information:

*Email address:

*Home Phone:

() -

Cell Phone:

() -

Questions

*How did you hear about the Anake Outdoor School?

*Why do you wish to enroll in the Anake Outdoor School?

*Why do you consider yourself an excellent candidate? Include any experience with the skills taught in the Anake Outdoor School.

*What do you hope to accomplish by graduating from the Anake Outdoor School

Anything else you'd like to tell us about yourself as an applicant to the Anake Outdoor School?

References

Please provide two personal references we can contact. (Former supervisors and/or teachers/professors preferred)

Reference 1

*First:

*Last:

Email address:

*Phone:

Daytime () - Evening () -

*Relationship:

Reference 2

*First:

*Last:

Email address:

*Phone:

Daytime () - Evening () -

*Relationship:

Finances

*How do you plan to finance your participation in the Anake Outdoor School?

Sufficient funds to pay in full

Sufficient funds to pay at the established payment schedule

I'll need to get a loan to pay for the program

I'll need to work during the program to pay for the final tuition payment

I'll need to work during the program AND get a loan

I plan to use VA benefits to pay for the program

Other (please explain below)

Don't know

Comments:

Certification

*In checking this box, I certify that to the best of my knowledge the statements I have made in this application are complete and true.

Wilderness Awareness School does not discriminate on the basis of race, color, religion, age, sex, disability, national or ethnic origin, or sexual orientation. Wilderness Awareness School is an Equal Opportunity Employer.