2019 Transportation Safety Leadership Training Application
Thank you for you interest in the 2019 Transportation Safety Leadership Training. Please complete this application by 5pm on March 1, 2019 to be considered. Selected candidates will be notified by Tue, March 5, 2019.

Questions?

Project Info and Eligibility: Debbie Spiliotopoulos, NVRC at dspilio@Novaregion.org

Registration and Class Info: WABA at education@waba.org

First Name *
Your answer
Last Name *
Your answer
Organization *
Your answer
Job Title *
Your answer
Street Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Phone Number *
Your answer
Email *
Your answer
Gender *
Spoken Language(s) *
Your answer
Age *
Your answer
Check the training events you wish to apply for. By checking an event you are confirming your commitment to attend all applicable dates. *
Required
List the outreach events you are committing to completing. Select a minimum of three (3) outreach events from the outreach calendar provided (see "Key Requirements" at waba.org/questions/#training) or list other events that provide safety outreach in the region (provide details on event name, date, purpose, host, and description of activity) *
Your answer
Do you commit to report on all outreach activities and events and provide follow-up information and evaluations to NVRC? *
Who is your mentor? Include Mentor name, title, affiliation, email, and phone number. Select someone who can help you connect with safety outreach events and verify your outreach requirements are completed after training. *
Your answer
Does your mentor commit that you will complete the requested training and activities *
Why do you want to receive this training? *
Your answer
Why do you think this training will be useful for you? *
Your answer
How comfortable are you riding a bike for an extended period of time on roads? *
When was the last time you rode your bike for at least 30 minutes in city traffic. *
When was the last time you rode your bike for at least 30 minutes on a mixed use path or trail. *
Approximately how often do you walk or hike? (If interested in Pedestrian Safety Training)
What distance do you typically walk or hike? (If interested in Pedestrian Safety Training)
What is your comfort level walking or hiking? (If interested in Pedestrian Safety Training)
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