Foundational Apprenticeship Application
General Information
Name
First Name
Last Name
Preferred Pronouns
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Age
Birthdate
-
Month
-
Day
Year
Date
Emergency Contact Name
Emergency Contact Phone Number
Do you have any allergies?
Yes
No
If yes, what are you allergic to? Do you have an epi-pen?
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Course Interests
How did you hear about Wildness Within?
Have you taken classes with Rachael? If so, which ones?
Why are you interested in taking this apprenticeship?
What are you hoping to learn?
What previous experience do you have with plants?
Do you have any previous education/experience in health science?
Do you have any previous education/experience in ecology, natural history, or naturalist skills?
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Course Logistics
Are you able to attend all of the classes? If not, how many do you anticipate missing?
Are there any scheduling conflicts?
What's your experience and level of comfort in being outside in the garden and woods? Describe ability to garden, hike, camp, etc.
Are you able to walk on uneven ground, uphill, or long periods of time, etc?
Do you have any health concerns that may affect your participation in the program?
Any other comments/inquiries/helpful information?
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Work Trade
Please fill out if you would like to be considered for work trade.
Describe financial need for work trade position:
Are you part of a marginalized group?
Are you able to do manual labor outside? Are you able to work in the herb kitchen? Are you able to work on the computer? Do you have a preference?
Are you able to work for 3 hours on Wed or Thurs during weeks of program?
Yes
No
Would you be able to take this course without doing work trade?
Yes
No
Submit
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