2005 ACA logo American Canoe Association
Safety Education and Instruction Council
SEIC Club Questionnaire
 
 

Directions

Infomation submitted with this form will be held in confidence and used only to help the SEIC and the ACA better serve all clubs. Fill out as much of the form as you feel comfortable with, any of data you can share will be useful in helping develop new and targetted training programs and to aid in formulating clubs policy at the ACA.

When you are done click on the "Submit" button. If you have multiple contacts or want to send more details, reset the form, fill in the new information and submit a second version. If you have further questions about this form you may use the comment box at the bottom.
 
 
  BASIC INFORMATION:
* Required Fields
Oganization Name: *

ACA Number: *

Website:

ACA Club Type:


ACA/SEIC CONTACT:

First Name: *

Last Name: *

Title:

Address-1:

Address-2:

Town:

State:

Zip Code:

Phone number: *

E-mail address: *
 		 
ORGANIZATION MAKEUP:
Number of Members:
  ACA Members:

 
What are your organizational focus areas?
Use pull-down menus if possible.
Focus Areas   Percent Membership
 
 
Other Focus Areas   Percent Membership
 
 
 
ORGANIZATION RESOURCES
Is there a Safety Coordinator?
Safety Name:

  Safety E-mail:

 
Is there a Training Coordinator?
Training Name:

  Training E-mail:

 
Is the organization incorporated?
Corporation Type:

  Incorporation State:

 
Are you part of a larger organization?
Parent Organization:

  Parent Focus:

 
 
  INSTRUCTIONAL RESOURCES
If you have Instructor members, please list them here:
 
 
Instructor   Discipline   Certification   Cert. Org.

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 

 
 
 
 
If you use an outside training organization, please enter it here:
 
  ORGANIZATIONAL PLANNING
 
 

Goals: What are the goals of your organization and how will you achieve them?
 
 
 

Affiliation: How does affiliation with ACA and SEIC help meet your goals?

 
 
 

Challenges: What are the most difficult challenges facing your organization?

 
 
  Support: How can the ACA and SEIC help meet your challenges?
 

  Comments: I have the following questions or comments on the form.
 

   
 


 
Copyright 2006 by ACA SEIC. All rights reserved.