ASA-107A Instructor Qualification Clinic Application 201 and 210 - Rev 3/21/19

Sep 24, 2026

Uploaded by Fahsai

Instructor Qualification Clinic application form for ASA courses 201 and 210. Collects personal information, including contact details and ASA ID, and requests disclosure of prior felony convictions. Includes sailing experience questions covering learning history, crewing, skippership, and chartered/rented experience with years and locations. Requests navigation qualifications, racing and markset experience, history of accidents causing bodily injury, and teaching experience, followed by agreement to study requirements, ASA Terms and Conditions, and ethics.

LanguageEnglish

CategoryExam

FormatPDF

Pages2

Reading Time5 min

AccessFree to download

Personal Information

Sailing Experience

Declarations and Agreement

201 & 210 INSTRUCTOR QUALIFICATION CLINIC APPLICATION I. PERSONAL INFORMATION: Last Name First Name MI ___________________________ Address: City State | Zip Code E-mail: Telephone: Residence/Cell: ( ) Business: ( ) ASA ID Number \#: Have you ever been convicted of a felony? Check One: No: Yes: If yes, please explain on a separate sheet. Registering for 201 210 (210 Must accompany copies of the CPR/First Aid Cards.) II. SAILING EXPERIENCE: (101 Basic Keelboat required for instructor certification) 1. How and where did you learn to sail? Include contact names and numbers if possible. ________________________________________________________________________________________ 2. What types of small boats, keelboats and multihulls have you crewed on, \# years, and where? 3. What types of small boats, keelboats, and multihulls have you skippered, \# years, and where? 4. What types of small boats, keelboats, and multihulls have you chartered/rented, \# years, and where? ________________________________________________________________________________________ ASA-107A-To apply for the Instructor clinic. Rev 3/21/19 5. Explain your navigational qualifications, racing experience, racing direction, and markset experience, if any: ________________________________________________________________________________________ 6. Have you ever been responsible for a boating accident where another person sustained bodily injury? Yes No: If yes, attach an explanation. 7. Where and what is your teaching experience? ________________________________________________________________________________________ ________________________________________________________________________________________ I understand fully that by signing this agreement I have studied, and prepared for the intense requirements to become an Certified ASA Instructor. I agree to the Terms and Conditions and the ASA Code of Ethics to the best of my ability. I understand that once I am an ASA Certified Instructor I will need to certify students through an ASA Affiliate School. Name: Date: ASA-107A-To apply for the Instructor clinic. Rev 3/21/19

FAQs

What personal information is required for the ASA instructor clinic application?

The form requests last name, first name, middle initial, address, city/state/zip, email, and telephone numbers, plus an ASA ID number.

What sailing experience details must applicants provide?

Applicants must describe how and where they learned to sail, specify types of boats and multihulls they have crewed on, skipped, and chartered/rented, including the number of years and locations.

What declarations and acknowledgements are included at the end of the form?

Applicants confirm they studied for the requirements to become a certified ASA instructor, agree to ASA Terms and Conditions and the ASA Code of Ethics, and understand student certification must be done through an ASA Affiliate School.

Sep 24, 2026

Uploaded by Fahsai