To help us monitor the effectiveness of our programs, we request that you furnish AMSEA with information about each cold water safety course, workshop or seminar you teach. AMSEA also uses the information for quarterly activity reports, funding proposals, program justification, and to serve you better.

Fill in the blanks below and click the submit button to send it to us. Click the reset button to clear the form for the next entry. Please be specific in your answers.

PLEASE NOTE: If you submitted a pre-course reporting form AND your training included persons age 18 and over (16 and over for FV Drill Conductor Courses), please submit a completed Course Roster/Reporting Form instead of this post-course report.

Download a printable Course Roster/Reporting Form here, complete it, and mail or fax it to AMSEA.

Thank you!

Primary Instructor Name:

Primary Instructor E-mail Address:

Primary Instructor Phone:

Additional Instructor Name(s): (enter NA if none)

Course Information

Dates: (mm/dd/yyyy)
Start:     End:

City where the course was held:

Name of the organization, school, business or other group for which you provided this course:

State:

Country:

Length of Course (total hours):

Course Name or Type (choose one):

Fishermen's Workshop
AK Water Wise (AWW) only
Expanded course for rec boaters that included AWW
Emergency Procedures for Recreational Boaters (EPRB)
Other course for recreational or subsistence boaters
Course for children
Course for children & parents or other adults
Custom course for adults associated with an organization, government agency, or business

If the type of course that you taught is not listed here, please download and fill out a printable Roster/Reporting Form and mail or fax the completed form to AMSEA. Thanks!

Course Partcipant Information

Number of partcipants over age 18 :
Number of partcipants age 18 and under :

Comments: