Division of Student Affairs

Challenge Course Program Request

We will contact you to arrange payment. Accepted methods include check, credit card, and departmental transfer (FOP).

Contact Person Information

Contact person Required

Day phone Required

Evening phone Required

Address Required

City Required

State Required

Zip Required

Email Required

Group Information

Group name Required

Number in group Required

Age range Required

How long has the group been together? Required

Will they know each other’s names? Required

Yes

What specific issues are important for this group? Please rank as a 1, 2, or 3 for all that apply Required

	1	2	3	NA
Goal setting Required	Goal setting - 1	Goal setting - 2	Goal setting - 3	Goal setting - NA
Problem solving Required	Problem solving - 1	Problem solving - 2	Problem solving - 3	Problem solving - NA
Decision making Required	Decision making - 1	Decision making - 2	Decision making - 3	Decision making - NA
Teamwork Required	Teamwork - 1	Teamwork - 2	Teamwork - 3	Teamwork - NA
Self-Confidence Required	Self-Confidence - 1	Self-Confidence - 2	Self-Confidence - 3	Self-Confidence - NA
Creativity Required	Creativity - 1	Creativity - 2	Creativity - 3	Creativity - NA
Socialization / Getting to know each other Required	Socialization / Getting to know each other - 1	Socialization / Getting to know each other - 2	Socialization / Getting to know each other - 3	Socialization / Getting to know each other - NA
Leadership Required	Leadership - 1	Leadership - 2	Leadership - 3	Leadership - NA
Peer Respect Required	Peer Respect - 1	Peer Respect - 2	Peer Respect - 3	Peer Respect - NA
Trust Required	Trust - 1	Trust - 2	Trust - 3	Trust - NA
Risk Taking Required	Risk Taking - 1	Risk Taking - 2	Risk Taking - 3	Risk Taking - NA
Commitment Required	Commitment - 1	Commitment - 2	Commitment - 3	Commitment - NA
Communication Required	Communication - 1	Communication - 2	Communication - 3	Communication - NA

What are the group’s strengths and weaknesses? Required

Group Objectives Required

Please describe the end result that you envision for your groups’ challenge program experience. Course objectives may include reference to: trust, communication, and working roles. Issues such as active participation, risk taking, responsibility, challenge and support may also be addressed.

Program Information

Program type Required

Low Ropes Program

Climbing Rappelling Tower

Teambuilding

Desired length of program Required

Desired dates and times for program Required

Are there any limitations or health concerns we should be aware of when designing your program? Required

Please list any specific goals for the program that may be different or more specific then your objectives previously listed. Required

Leave this field blank

Campus Recreation

Student Affairs, Division of

Location:

092 Student Union

Phone:

937-775-5505

Fax:

937-775-5527

Email:

billy.willis@wright.edu

Student Affairs, Division of

Location:

210 Student Union

Phone:

937-775-2808

Fax:

937-775-3669

Email:

deanofstudents@wright.edu

Campus Recreation

Campus Recreation

Challenge Course Program Request

Campus Recreation

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