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Aerie Wilderness Medicine Semester Inquiry
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Name
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Phone
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Address
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Date of birth (students must be 18 or older)
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Parents' name(s) and contact information, if applicable
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Which Aerie semester or semesters interest you?
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Do you have prior outdoor experience?
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Have you served in any of the following:
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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?
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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?
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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?
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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?
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Do you have any injuries, allergies, or dietary restrictions?
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Emergency contact: name/relationship/phone number
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Is there anything else you'd like us to know before we reach out?
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