PCSS WILD Program
2024 Wilderness Initiatives for Leadership Development Program Application
Student Name
First Name
Last Name
Pronouns
Parent/Guardian Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Student Grade
Student Email
Parent/Guardian Email
Parent/Guardian Phone
SCHOOL REFERENCE
Teacher/Administrator reference should have taught/coached/worked with you within the last 2 years.
Which school do you go to?
Teacher Reference Name
Teacher Email
example@example.com
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Tell us about yourself
To apply to WILD, please answer the following questions. There are no right or wrong answers to the questions – we’re simply trying to get to know you a little better. So feel free to answer the questions any way you would like.
Have you participated in any of the following programs?
PCSS SASE
PCSS LEAD
PCSS FADS
WS OPES
WS ACES
WS ES
WS CHAOS
WS FACES
WS PASE
WS MAD
Other
Why do you want to join the WILD program?
What strengths and skills will you bring to the WILD program?
Provide an example of where you have taken a leadership role in the past.
What activities excite you the most with the WILD program? (Snowmobiling, Avalanche Training, Whitewater, Camping, etc.)
Is there anything that you are hesitant about for WILD?
SELF-EVALUATION CHECKLIST. When completing this self-evaluation form, please rate yourself in the following areas using a scale of 1 to 5 with 1 being very poor and 5 being outstanding
1
2
3
4
5
Respectful
Works well with groups
Works independently
Shows initiative
Participates and is engaged in class
Deals with adversity in a positive manner
Embraces challenges as opportunities to learn
Listens/follows directions
Would benefit from WILD
Have you applied to any other programs next year?
Yes
No
If Yes, which ones?
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WILD Activities
Rate your excitement for the following activities:
Leadership Activities and Presentations with different PCSS classes
1
2
3
4
5
Winter Camping
1
2
3
4
5
Wilderness Cooking and Baking
1
2
3
4
5
Snowmobiling
1
2
3
4
5
PCSS Bison Hunt
1
2
3
4
5
Avalanches Skills Training
1
2
3
4
5
Whitewater Rescue and Swimming
1
2
3
4
5
Whitewater Canoeing, Rafting, & Packrafting
1
2
3
4
5
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