Nomination Form Freight Academy Nomination Form Due: February 24, 2023 Name* First Last Agency* Title* Work Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Work Phone*Cell Phone*Email* Type of Agency* Federal State Local (City, County) MPO Law Enforcement Other (please specify) Supervisor Information:Supervisor Name* Supervisor Phone*Mailing Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Supervisor Email* General InformationDescribe 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 and fees. Program Dates: June 11 – June 16, 2023 The program will be in-person. Pre-Event Virtual Sessions: There will be two 90 minute pre-event virtual program sessions. The dates of the virtual sessions will be announced soon. See the Draft Agenda for details (main menu under Program, Agenda). Fees: Program Fees (required): $4,950 This fee includes food, lodging and program field trip transportation (for Federal agency attendee rates contact Freight Academy Program Manager Marygrace Parker mgparker@tetcoalition.org) Immersion Program* I agree I understand that is this a six-day immersion program, which requires attendance at all events and lodging at onsite facility. 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) *Eastern Transportation Coalition Scholarship Selection Criteria: Application Quality Potential to enhance freight planning and/or freight related operations and mobility On staff at Coalition member, affiliate or associate agency Active involvement in Coalition activities Contribution to multi-disciplinary and multi-agency collaboration Equitable distribution across Coalition members All program fees will be due on April 5, 2023, 5 weeks after notification of acceptance into the program. If your agency is paying for your participation, we will reach out to you for payment details.
