Application for Instructor Training

Please fill out the following information to submit an application for The Safe Routes to School National Course Instructor Training. Fields marked with an asterisk (*) are required.

Your Information

* Applicant Name

* Organization Name

* Address

Address 2

* City

* State

* Zip Code

* Email

* Telephone

Application Questions

Please respond to each question in no more than approximately 250 words (1500 characters).

* 1) Why are you interested in teaching the SRTS National Course?

* 2) The Course is designed to be taught by two people; one person who has experience with infrastructure and the other with non-infrastructure. Infrastructure instructors usually possess experience in transportation engineering or planning. Non-infrastructure instructors usually bring experience in education, public health, or pedestrian/bicycle subject matter. Please describe how your experience fits.

* 3) What are your plans to teach the Course? How does it fit into your current role or responsibilities?

* 4) How would attending the Instructor Training improve your ability to support a SRTS program (or more than one)?

* 5) In order to teach the Course, both instructors need to have participated in a SRTS National Course Instructor Training. Please explain your plans for a co-instructor. Who would you teach with? If not yet known, how will you find someone? To see a list of past instructor training participants, go to http://www.saferoutesinfo.org/training/national_course/instructors.cfm.

Optional

As part of the National Center for Safe Routes to School's commitment to building capacity for training nationwide, up to five registrations are available for $1500 instead of the standard $2500 fee. Up to two registrations are available for no cost to the participant.

To be considered for one of these options, there are two ways to qualify:

Work for a non-profit organization, school or local government.
Demonstrate commitment to teach the Course at least two times at no charge to the participants or sponsoring group.

Describe how you fit one or both of the qualifications and indicate whether you are requesting the $1500 subsidized fee or to have the fee waived.

Applications are due by August 30, 2010.

All applicants will be notified of selection status by September 15, 2010.

Participants are expected to confirm their attendance by September 22, 2010.