MIT Course Intake Form

If you are the point of contact for a MIT Course, please fill out the following form to help us plan logistics for the class!

Course Intake Form

Course Location(Required)

Who is the Course For?(Required)

Tribe, Organization, Company, etc.

Point of Contact

Name(Required)

First Last

Title(Required)

Email(Required)

Phone(Required)

Classroom/Training Area Details

Classroom Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Can we leave stuff on site?(Required)

Has cell service?(Required)

Has internet we can access?(Required)

Has parking available?(Required)

Can parking accommodate the students and instructors (3 vehicles and sometimes 1 trailer)?

Has bathrooms?(Required)

Are there enough bathroom facilities for all students and instructors?

Has big enough classroom?(Required)

Will the classroom accommodate all students and instructors?

Has tables and chairs for students?(Required)

Will there be enough chairs and tables for all of the students?

Has Close By Outdoor Training Area?(Required)

Is there a decent area for outside traininig?

Has On Site Fridge?(Required)

Is there an on site fridge to store perishables?

Has Nearby Lodging?(Required)

Is there an on site fridge to store perishables?

Has Nearby Lunch Spots?(Required)

Are lunch spots easy to get to within about 10-15 minutes?

Lodging/Lunch Options Notes

Please provide details. Nearby recommended lodging locations. Can students get to lunch and back in an hour? etc.

Earliest date we can access training area?(Required)

Earliest time we can access training area?(Required)

What time does the training area close?(Required)

What type of litter device do you have available for training?(Required)

Backboard

NAR Rescue Sleeve

Stokes Basket

Sked

TRS (Traverse Rescue System)

None

Upload your expected course roster

Max. file size: 200 MB.

Please include student first name, last name, agency/dept, contact phone, contact email