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Facilitator Name*
Email*
FacID*
Program Date*
Client*
ProgID*
Number of Participants
Actual agenda/timeline and specific activities presented*
Observations (bullet points: Include overall program and team dynamics as well as reflections from each activity)
OPTIONAL Attachment: Upload additional supporting document (e.g., in case of formatted texted or more detailed report to share with client):
How did you find out about AAI?
Web Search
Colleague Referred Me
AEE
Worked with AAI Before
Other
Facilitation Experience
Please check the most accurate description of your skills and experience with each of the following.
Ctrl + click to select multiple
I have facilitated youth/camp programs
I have co-facilitated adult groups
I have facilitated adult groups
I have facilitated corporate teams
MBTI
I don't know what the letters stand for
I know my type preference and am familiar with the concepts
I have co-facilitated or assisted with an MBTI training workshop
I am qualified and have administered MBTI in a corporate setting
DiSC
I don't know what the letters stand for
I know what my profile is and am familiar with the concepts
I have co-facilitated or assisted with a DiSC training workshop
I am qualified and have administered DiSC in a corporate setting
Sailing
Forget it. I get seasick taking a bath
I am familiar with sailing recreationally
I have co-facilitated or assisted with a team building sailing program
I have been the lead facilitator for a corporate sailing workshop
Orienteering
That's with a map and compass, right?
I am very skilled getting around with a map and compass
I have co-facilitated or assisted with a team orienteering program
I have been the lead facilitator for a corporate workshop that implemented orienteering
GPS
Global positioning station, right?
I have used a handheld GPS device
I have co-facilitated or assisted with a team building GPS program
I have been the lead facilitator for a corporate GPS workshop
Indoor Rock Climbing
Never did it
I am an experienced rock climber
I have co-facilitated or assisted with a team building rock-climbing program
I have been the lead facilitator for a corporate rock-climbing workshop
Ropes Course
I know what it is
I have participated in low and high ropes course elements
I have co-facilitated or assisted with a team building ropes course program
I have been the lead facilitator for a corporate ropes course workshop
Logistics
Hate it
I have organized personal adventures
I have assisted with the logistics for large group events
I have been the lead logistics coordinator/facilitator for a corporate event
I am a US Coast Guard certified sailing instructor.
Yes
No
I can set a temporary orienteering course.
Yes
No
I can set a GPS course.
Yes
No
My Standard First Aid/CPR training is current.
Yes
No
My Standard First Aid/CPR training expires (mm/dd/yy):
I am EMT trained and my training is current.
Yes
No
Please list your affiliations with professional and/or recreational affiliations, associations and training certifications (for example, AEE, ASTD, etc.)
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