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Aerie Wilderness Medicine Semester Inquiry
Welcome! We’re delighted that you’re considering an intensive backcountry training experience with Aerie. Please fill out the short inquiry form below. This helps us get to know you and make sure the program is a good fit. The form should take 5 to 10 minutes to complete, after which Semester Program Director David Kerner will reach out by email or phone to give you details and answer your questions. All the information you supply is confidential, to be used for planning purposes and as a jumping off point to explore your enrollment.
Note: No prior medical or outdoor experience is required—but motivation and resilience are essential.
Name
Name
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Phone
Phone
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Address
Address
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Date of birth (students must be 18 or older)
Date of birth (students must be 18 or older)
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Parents' name(s) and contact information, if applicable
Parents' name(s) and contact information, if applicable
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Which Aerie semester or semesters interest you?
Which Aerie semester or semesters interest you?
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Spring semester, January to April
Fall semester, August to November
Summer semester, June to July
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add "Other"
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Do you have prior outdoor experience?
Do you have prior outdoor experience?
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Recreational sports, i.e., hiking, biking, skiing, surfing, rafting, climbing
Multi-day recreational trips
Professional outdoor experience
No, but I'm eager to learn!
Other:
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Have you served in any of the following:
Have you served in any of the following:
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AmeriCorps
Montana Conservation Corps
Washington Conservation
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Do you intend to use education grants or scholarships to pay for the program? If so, please provide details below.
Do you intend to use education grants or scholarships to pay for the program? If so, please provide details below.
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Do you have prior medical training?
Do you have prior medical training?
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EMT
WFA or WFR
First Aid/CPR
OEC/Ski patrol
Not yet, but I'm hoping to change that!
Other:
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What interests you most about doing a semester in wilderness medicine with Aerie?
What interests you most about doing a semester in wilderness medicine with Aerie?
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How did you hear about Aerie's programs?
How did you hear about Aerie's programs?
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From Aerie's website
From Aerie's email list or newsletter
From Aerie's social media
Through another organization
Through a college promotion
By word of mouth
Other:
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This program involves long days outdoors in rugged terrain. Do you have any concerns about your physical or emotional readiness for these challenges?
This program involves long days outdoors in rugged terrain. Do you have any concerns about your physical or emotional readiness for these challenges?
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No, when can I start?
I think it will be manageable, but let's talk about it in more detail so I can be sure.
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Do you have any physical or mental health issues that may affect your participation in backcountry travel in challenging conditions or emergency medical simulations?
Do you have any physical or mental health issues that may affect your participation in backcountry travel in challenging conditions or emergency medical simulations?
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Yes
No
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Do you have any injuries, allergies, or dietary restrictions?
Do you have any injuries, allergies, or dietary restrictions?
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Emergency contact: name/relationship/phone number
Emergency contact: name/relationship/phone number
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Is there anything else you'd like us to know before we reach out?
Is there anything else you'd like us to know before we reach out?
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