www.outdoorsforall.org | 206.838.6030 | info@outdoorsforall.org 6344 NE 74th St. Suite 10 2 Seattle, WA 981 15 Program Internship Application Thank you for your interest in working with the Outdoors for All Foundation. We look forward to working with you as we fulfill our mission of improving the quality of life for children and adults with disabilities . Please help us by c ompleting the information below. Please attach a resume as well . I am applying for an internship in : Day Camp Recreation Management Outdoor Recreation 1. Personal Information Last Name: First Name: M.I.: Home Address: City: State: Zip: Home Phone: Additional Phone: E-mail Address: Date of Birth: Driver’s License Number: State: I understand that by signing this form, I am giving permission for Outdoors for All, a non -profit organization, to request Criminal History information and Child/Adult Abuse through Information Act from the Washington State Patrol Identification & Criminal History Section in accordance with RCW 43.43.830 through 43.43.845 Signature: __________________________________________________ 2. Education and Training College: School Address (if different from above): City: State: Zip: School Phone (if different from above): Field of Study/Major: Minor: 3. Employment (please list your current or most recent place of employme nt) (Training Employer: Work Phone: Address: City: State: Zip: Job Title: Hours per Week: 4. Related Volunteer or Work Experience (Attach Additional Sheet if Necessary) www.outdoorsforall.org | 206.838.6030 | info@outdoorsforall.org 6344 NE 74th St. Suite 10 2 Seattle, WA 981 15 Organization/Agency: Phone: Address: City: State: Zip: Summarize Work Duties: ✓ Please rate your experience level with any speci al skills or services : 0 – none ; 1 – Novice; 2 – Some; 3 – Average; 4- very experienced __Bicycle Maintenance __Belaying __Setting Climb Anchors __Challenge Course Experience __Initiative Game Leading __Bicycling __Adaptive Cycles __Kayaking __Hiking __Canoeing __American Sign Language __Arts & Crafts __Customer Service __Public Speaking __Driving a Passenger Van Please explain or expand on your experience and add any additional experience not listed. ✓ Certifications I have th e following certifications : CPR Yes No Date Certified: _ ______________ Expires: _ __________ First Aid Yes No Date Certified: _ ______________ Expires: _ __________ Belay Certification Yes No Date Certified: _ _________ _____ Given by: __________ WFR Yes No Date Certified: _ ______________ Expires: _ __________ Lifeguard Certified Yes No Date Certified: _ ______________ Expires: _ __________ CTRS Yes No Date Certified: _ ______________ Other: _ _____ _____________ Date Certified: _______________ Expires: _ __________ ✓ Outdoor Leader List all of the activities that you have co-lead or lead yourself - Kayaking, Rock Climbing, Hiking, Camping, Horseback riding - any relevant activities that you hav e experience leading or co -leading. ✓ Disability Related Programs www.outdoorsforall.org | 206.838.6030 | info@outdoorsforall.org 6344 NE 74th St. Suite 10 2 Seattle, WA 981 15 Please expand on your experience with children and/or adults with disabilities . Related experience can be as a result of volunteer, job, or personal knowledge. Please include specific disabilities you’ve worked with, such as Autism, Intellectual Disabilities, Downs Syndrome, Cerebral Palsy, etc. ? Comments and Questions Please include any additional comments or questions you have for Outdoors for All .
