PCSS Wilderness Initiatives for Leadership Development Program

PCSS WILD Program

2024 Wilderness Initiatives for Leadership Development Program Application
Student Name

First NameLast Name
Pronouns
Parent/Guardian Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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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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

PCSS WILD Program