Grant Course Waitlist Submission Form

Grant Course Waitlist Submission Form

This form allows you to express your interest in either hosting an ATSSA Training Course for a group or attending an ATSSA Training Course. Submitting this form will add you to the ATSSA waiting list for your chosen option
Your Full Name*

First NameLast Name
Your Business/Organization Title
Organization/Business Name
Requester Type (choose one)*

Public AgencyPrivate BusinessIndividual
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Completion of the questions will not impact your place on the waiting list. The information collected is necessary to assist ATSSA with future course scheduling.

How many attendees would you be Hosting for? If you are not Hosting, please skip this question.
How many people would be attending each Course, average?
Would your group be willing to answer individual Demographic information?

YesNo
Are you or anyone in your group seeking certification?

YesNo
Do you need any accommodations in order to attend the Course? If Yes, Please type the nature of your request.
Please click the "Submit" button for your response to be placed on to the waiting list. By doing this, you will receive periodic updates and a confirmation email of your submission data. By clicking Submit you understand that this material was produced under a grant from the Occupational Safety and Health Administration (OSHA), U.S. Department of Labor and U.S. Department of Transportation Federal Highway Administration (FHWA). It does not necessarily reflect the views or policies of OSHA or FHWA nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government.

If you have specific questions regarding this form please email Courtni Somerville.
Do you have questions or comments?
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