Operations Academy Nomination Form Due: May 27, 2022 Name* First Last Organization* Title* Work Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work Phone*Cell Phone*Email* Type of Organization* Federal State Local (City, County) MPO Law Enforcement Other (please specify) Other Type of Organization Supervisor Information:Supervisor Name* Supervisor Phone*Mailing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Email* General InformationResponsibilities* Operations planning (regional cooperation, funding sources) Social, environmental and institutional issues (including public/private partnerships) Freeway operations Corridor management Surface street operations (including signal operations) Project management (including return on investment, performance measures, contracting) Traffic engineering Traffic control devices TSM&O and/or ITS Systems engineering (including standards) Other (please specify): Other Responsibilities Briefly describe your current responsibilities*(Your description may be as long as necessary.Why do you want to participate in this program?*(Your description may be as long as necessary.What do you expect to get out of the program?*(Your description may be as long as necessary.Emergency Contact InformationContact Name* Phone Number* Relationship to You* Nominating Organization Information Must be a Federal, state or local transportation agency. Organization* Contact Name* Contact Phone* Contact Email* Program Dates and Fees Please note the dates, fees and select polo shirt size. Program Dates: The program will be HYBRID in 2022. Virtual Days: Sept 21, 2022, Day 1 Sept 28, 2022, Day 2 Oct 5, 2022, Day 3 Oct 12, 2022, Day 5 Oct 13, 2022, Day 6 In-person:Oct 17-21, 2022 See the Draft Agenda for details (main menu under Program, Agenda). Fees: Program Fees (required): $3,909 Food and Lodging (required): $988 Total Fees (required): $4,897 You will receive an Operations Academy polo shirt. Please tell us your size:* Small Medium Large X-Large 2X-Large 3X-Large Payment OptionsHow would you like to pay for the program?* Eastern Transportation Coalition Scholarship* Purchase Order Check (made payable to the University of Maryland) Credit Card (will need to call with number) University of Maryland Scholarship *Eastern Transportation Coalition Scholarship Selection Criteria: (click here) Application Quality Potential to enhance TSM&O implementation Active involvement in Coalition activities Contribution to creating a multi-disciplinary academy Equitable distribution across Coalition members All program fees will be due on July 22, 2022, 6 weeks after notification of acceptance into the program. Any cancellation must be received by July 23, 2022 which is 60 days prior to the start of the program in order to receive a refund of all fees, less a non-refundable amount of $500. No refund of any fees will be granted if cancellation occurs with less than 60 days prior to the start of the program. If your agency is paying for your participation, we will reach out to you for payment details. Sept/Oct 2022 Operations Academy Nomination Form Due May 27, 2022