PLEASE READ BEFORE BEGINNING YOUR APPLICATION.

Applicant:

We require the below document to be downloaded and filled out by your supervisor(s). Once the document has been filled out, please upload the document when prompted within the application. You may submit more than one copy if you have more than one supervisor. 

You must ensure you have met all the below criteria for hours before submitting this form. If you received supervision from more than one supervisor each supervisor must complete a separate form. Each supervisor should indicate only the dates and hours for which s/he provided supervision. All forms from all supervisors combined should total the minimum hours required.

Applicant:

We require the below document to be downloaded and filled out by your supervisor(s). Once the document has been filled out, please upload the document below. You may upload more than one copy if you have more than one supervisor. 

You must ensure you have met all the below criteria for hours before submitting this form. If you received supervision from more than one supervisor each supervisor must complete a separate form. Each supervisor should indicate only the dates and hours for which s/he provided supervision. All forms from all supervisors combined should total the minimum hours required.

• Completion of 300 direct service hours of therapeutic adventure specialist specific experience accumulated over a minimum of 90 days.
• In addition to the 300 direct service hours, applicants must complete at least 50 supervision hours of therapeutic adventure specialist experience verified by the supervisor. Supervision must be distributed throughout the direct client hours and can be conducted individually or in a group setting.
• Total Hours of Therapeutic Adventure Specialist Experience: 300 direct service hours + 50 supervised hours = 350 total hours of experience.

Legacy Application Notice: If you will be using an addendum to explain your Adventure Therapy Training and experience, Please enter the word "Addendum" into the form below.

This acknowledgment and agreement must be read, understood, and signed by Applicant as a condition to Applicant’s certification as an adventure therapist by the Association for Experiential Education (AEE). Applicant acknowledges and agrees as follows:

Therapeutic Adventure requires various skills to facilitate adventure activities, including, but not limited to, games and initiatives, low ropes courses, and high-level challenge and adventure activities (including challenge courses at height, rock climbing, paddling, and other outdoor adventure pursuits). Regardless of the type of therapeutic adventure activity, the primary facilitator of the activity should have training in the technical skills required to reasonably manage its risks, including the level of emergency medical training appropriate to the setting (front country or wilderness).

A primary facilitator must meet one or more of the technical skill conditions described below to lead adventure activities:

●      Certified / Licensed – Hold certifications or licenses appropriate to leading the adventure activity and received from professional training organizations that follow professional and commonly accepted practices for their discipline and are consistent with the laws and regulations for the jurisdiction in which activities are conducted; or

●      Professional Training – Have received appropriate adventure activity training from professional organizations that follow commonly accepted practices for their discipline. Examples include organizations accredited by the Association for Experiential Education, American Mountain Guides Association, Association of Challenge Course Technology, and Colleges and Universities; or

●      Organizational Oversight - Training received is part of a program with commonly accepted risk management practices, staff training, and appropriate activity protocols.

I, Applicant, will:

●      Comply with the terms of this Agreement, and uphold the ethical and legal standards of a professional pertaining to the licenses/certifications I hold; 

●      Facilitate therapeutic adventure activities in a manner consistent with my competence and training;

●      Reasonably ensure that technically competent instructors act as primary facilitators of the technical aspects of the adventure activities I offer if I am not certified or professionally trained and assessed as competent to facilitate.

I represent that information, statements, and documents accompanying my application for certification or renewal is accurate, including my experience, education, training, and expertise. I am solely responsible for the accuracy of such information, statements, and documents, and AEE is not responsible or liable for any inaccurate or misleading information.

 I agree to notify AEE if I immediately:

●      Have any disciplinary action taken against me by an applicable licensing or certifying authority;

●      Have my license or certification suspended or revoked or a condition placed on my license or certification;

●      Am convicted of a crime related to my providing mental health services or a crime that would adversely affect the interests, effectiveness, reputation, or image of AEE;

●      I voluntarily relinquish my license or certification.

Failure to report any of the four conditions described above may result in the denial or revocation of my AEE Certified Therapeutic Adventure Specialist (CTAS)  credential.

I have read and am familiar with the AEE Certification Credentialing Manual and acknowledge and agree to the requirements of CTAS certification set forth therein.

I acknowledge and agree that certification as a CTAS by AEE is not intended to be and is not a representation or promise by AEE of my knowledge or competency, in my profession or otherwise, and that such designation confirms only that information and documentation received (which is not independently verified by AEE) reflects that the education and training requirements of AEE have been satisfied.                

I understand that if AEE receives a complaint against me, AEE will request that the complainant bring their concern to the overseeing body of the state license(s) I hold. After a formal resolution of the complaint, AEE reserves the right to take disciplinary action if it believes such is warranted.

I hereby agree to indemnify and hold harmless AEE from and against any and all claims, losses, actions, costs, and expenses, including attorneys’ fees and insurance deductibles, incurred by AEE as a result of or arising out of a) my acts or omissions in my treatment of patients; b) my failure to abide by the code of ethics, standards of practice and legal standards and requirements promulgated by my primary licensing authority; c) any falsification, including by omission or inclusion, of information on my CTAS application or any supporting documents; d) my conduct or actions that are prejudicial to the purpose, interests, effectiveness, reputation, or image of therapeutic adventure and/or AEE; and/or e) any other action or omission relating to my CTAS credential or my performance there under.