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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.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":20,"@type":76,"position":81},"https://docshare.wps.com/document/exam/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/asa-107a-instructor-qualification-clinic-application-201-and-210-rev-32119/388063/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/asa-107a-instructor-qualification-clinic-application-201-and-210-rev-32119/388063.png","ImageObject",300,407,{"name":92,"@type":93},"Fahsai","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-06","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What personal information is required for the ASA instructor clinic application?","Question",{"text":112,"@type":113},"The form requests last name, first name, middle initial, address, city/state/zip, email, and telephone numbers, plus an ASA ID number.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What sailing experience details must applicants provide?",{"text":117,"@type":113},"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.",{"name":119,"@type":110,"acceptedAnswer":120},"What declarations and acknowledgements are included at the end of the form?",{"text":121,"@type":113},"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.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},388063,1790742628,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":19,"category_name":20,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},549768702563,"https://ap-avatar.wpscdn.com/avatar/8000c4aa63b76e948b?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786536092046926083","201 & 210 INSTRUCTOR QUALIFICATION CLINIC APPLICATION  \nI. PERSONAL INFORMATION:  \nLast Name First Name   MI    \n___________________________  \nAddress:  \nCity   State | Zip Code   E-mail:   Telephone: Residence/Cell: ( )   Business: ( )    \nASA ID Number \\#:    \nHave 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.)  \nII. SAILING EXPERIENCE: (101 Basic Keelboat required for instructor certification)  \n1. How and where did you learn to sail? Include contact names and numbers if possible.  \n________________________________________________________________________________________  \n2. What types of small boats, keelboats and multihulls have you crewed on, \\# years, and where?  \n3. What types of small boats, keelboats, and multihulls have you skippered, \\# years, and where?  \n4. What types of small boats, keelboats, and multihulls have you chartered/rented, \\# years, and where?  \n________________________________________________________________________________________  \nASA-107A-To apply for the Instructor clinic.  \nRev 3/21/19  \n5. Explain your navigational qualifications, racing experience, racing direction, and markset experience, if any:  \n________________________________________________________________________________________  \n6. Have you ever been responsible for a boating accident where another person sustained bodily injury?   Yes   No: If yes, attach an explanation.  \n7. Where and what is your teaching experience?  \n________________________________________________________________________________________  \n________________________________________________________________________________________  \nI 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.  \nI understand that once I am an ASA Certified Instructor I will need to certify students through an ASA Affiliate School.  \nName:    \nDate:    \nASA-107A-To apply for the Instructor clinic.  \nRev 3/21/19","cbCaihL2H9mSCmws","https://ap.wps.com/l/cbCaihL2H9mSCmws","pdf",130428,"English","# Personal Information\n## Sailing Experience\n# Declarations and Agreement","[{\"question\":\"What personal information is required for the ASA instructor clinic application?\",\"answer\":\"The form requests last name, first name, middle initial, address, city/state/zip, email, and telephone numbers, plus an ASA ID number.\"},{\"question\":\"What sailing experience details must applicants provide?\",\"answer\":\"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.\"},{\"question\":\"What declarations and acknowledgements are included at the end of the form?\",\"answer\":\"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.\"}]","ASA-107A Instructor Qualification Clinic Application 201 and 210 - Rev 3/21/19 | PDF",1790293413]