Trip Leader Information
First Name
Last Name
Email Address
Your Title
School or Organization Information
Name of School or Organization
Type of Organization
Youth Org. After School
Youth Org. Summer Program
Youth Org. Outdoor/Environmental Education
Youth Org. Therapeutic
Public School K-12
Private School K-12
College or University
Other, youth worker
Other, non-youth worker
School District:
In which district, or independent school, do most of your students attend school? If applicable, list multiple districts.
Free or Reduced Lunch Qualifications:
Approximately what percentage of youth at your school or in your organization qualify for free or reduced lunch programs?
<40%
40%
50%
60%
70%
80%
90%
100%
Trip Information
Please Note:
All number fields must have a number. If you have no participants in a certain category the field should still read 0.
Which
gear library did you use?
Seattle
Pierce County
I didn’t borrow WTA gear
Did you receive WTA funding assistance support?
Yes
No
Date of Trip
Overnight trip?
No
Yes
Please list number of nights the trip lasted.
Trip Location
: Name of the trail, campground, park, or forest.
Number of Adult Participants:
Including the trip leader.
Additional WTA-Trained Adults?
Did other WTA workshop graduates participate in your trip?
No
Yes
Please list the full name of the other WTA workshop graduates who participated.
Number of Youth Participants
Grade Level of Youth Participants
: select all that apply.
Elementary
Middle School
High School
Post-High school (18-25)
Challenges and Successes
: Briefly describe any challenges your group faced during the trip and highlight any successes in overcoming obstacles or difficulties.
Positive Impacts
: Briefly describe any general or specific outcomes from your trip. Please share quotes or anecdotes that highlight the positive impacts of the trip on youth and adult participants.
Trip Photos:
If you're able, please share photos from your trip. Email the original files or saved images in high resolution to
gearlibrary@wta.org
. Please ensure that you have photo release forms for all persons identified in the photos. WTA may choose to share these photos on our website, in our publications, or through our other media outlets to maintain support for this program.
Your Demographic Information
Your Race or Ethnicity
: Please select the category or categories with which you most closely identify.
Alaskan Native
American Indian
Asian
Black
Latino
Pacific Islander
White
Multi-Racial/Multi-Cultural
Race/ethnicity is not represented here
Please specify below.
Your Gender
: Please select the category or categories with which you most closely identify.
Agender
Genderqueer
Non-conforming
Man
Woman
Gender is not represented here
Please specify below.
Do you identify as trans?
Yes
No
Prefer not to say
Your Age
Adult Participant Demographic Information
Race or Ethnicity of Adult Participants:
Please provide the number of adult participants (including the trip leader) which you believe most closely identify with the following categories.
Alaskan Native
American Indian
Asian
Black
Latino
Pacific Islander
White
Multi-Racial / Multi-Cultural
Unknown
Race/Ethnicity Not Represented
Please specify the races/ethnicities not represented.
Gender of Adult Participants:
Please provide the number of adult participants which you believe most closely identify with the following categories.
Agender
Genderqueer
Non-conforming
Man
Woman
Unknown
Gender Not Represented
Please specify the genders not represented.
Do any adults identify as trans?
Yes
No
How many?
Youth Participant Demographic Information
Race or Ethnicity of Youth Participants:
Please provide the number of adult participants (including the trip leader) which you believe most closely identify with the following categories.
Alaskan Native
American Indian
Asian
Black
Latino
Pacific Islander
White
Multi-Racial / Multi-Cultural
Unknown
Race/Ethnicity Not Represented
Please specify the races/ethnicities not represented.
Gender of Youth Participants:
Please provide the number of youth participants which you believe most closely identify with the following categories.
Agender
Boy
Genderqueer
Girl
Non-conforming
Unknown
Gender Not Represented
Please specify the genders not represented.
Do any youth identify as trans?
Yes
No
How many?
Questions / Comments
reCAPTCHA helps prevent automated form spam.
The submit button will be disabled until you complete the CAPTCHA.