Operations Academy Nomination Form

Due: May 27, 2022

Name*

First Last

Organization*

Title*

Work Address*

Street Address City 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 State ZIP Code

Supervisor Email*

General Information

Responsibilities*

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 Information

Contact 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 Options

How 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

Operations Academy Nomination Form

Supervisor Information:

General Information

Emergency Contact Information

Nominating Organization Information

Program Dates and Fees

Payment Options

Highlights