This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in
Online Application for the Alderleaf Wilderness Certification Program
Please note that all fields followed by an asterisk must be filled in.
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Mailing Address (if different from street address)
Highest Education Completed*
---Select--- Less than high school diploma
High school graduate
Some post high school, no degree or certificate
Certificate (less than two years)
Doctoral Degree or above
None of the above
Date of Birth*
Preferred Method of Contact*
Best Weekdays/Times to Contact During Business Hours: *
Last School Attended:*
Current / Most Recent Employer:*
Professional or Academic Reference (name, phone & email):*
Please tell us about yourself in a paragraph:*
Why do you want to attend this program?*
How do you plan to use this training?*
How did you first hear about Alderleaf Wilderness College?
---Select--- Friend or family member
Alderleaf eNewsletter email
If "other", please share:
Do you have any physical, psychological, or medical conditions which may influence your ability, or may require special adaptation, to complete your training in the program? If so, please explain so that we may work together to the best of our abilities.
How do you plan to finance your participation in the program?*
---Select--- Sufficient funds to pay in full
Sufficient funds to pay in two payments (Aug & Jan)
Will need to get a student loan and/or work during the program to pay tuition
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