ATSSA Roadway Safety Leadership Academy Application

ATSSA Roadway Safety Leadership Academy Application
To apply for the 2025-26 ATSSA Roadway Safety Leadership Academy, you must be an ATSSA member. Please complete and submit this application no later than Thursday, May 15, 2025.

ATTENDANCE POLICY AND EVENTS

To successfully complete the program, it is required that participants attend at least 80% of the scheduled classes and events to receive a graduation certificate.

SELECTION AND TUITION

Applicants will be receive notification of selection by Thursday, June 5, 2025.

If selected, you will be billed for the $2,900 non-refundable tuition. Payment is due no later than Thursday, June 19, 2025.
Name

First NameLast Name
Title
Company
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Email
example@example.com
Phone Number

Area CodePhone Number
What do you hope to gain by participating in this program?
Briefly describe your professional experience and goals:
Should be Empty: