PTSCTP Agency Participant Template

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Overview

Agency Information
Agency Participants

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Sheet 1: Agency Information

Agency Information
Agency:
Please provide contact information for a point of contact for PTSCTP related correspondences with FTA.
Last Name, First Name:
Position:
Email Address:
Phone Number:
Notes:
Agency Refresher Training Requirement
Please use the fields below to list the training courses or activities your agency has identified to satisfy the refresher training requirements of the PTSCTP. Please note that refresher training must include, at a minimum, one hour of safety oversight training. Please list the exact title of the courses or activities your agency has identified. Please use the text fields to indicate the name of the agency that developed the course or activity and the length of the course or activites (in hours). Please use the selection box below each course to indicate if the training course or activity applies to all tracks of the PTSCTP (e.g., SSOA, RTA, and Bus) or a specific track.
Number of courses that must be completed:				Please Select
Please describe if "Other":			Example: Agency employees and contractors must complete two of the identified courses or activities. Please update this description if you have selected "Other" as the number of courses that must be completed.
		The first entry is an illustrative example only and should be updated to reflect agency requirement.
Course Title:		Example: SMS Awareness
Course Developer:		Example: Transportation Safety Institute (TSI)
Course Length (Hours):		Example: 1 hour
PTSCTP Track:		All		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.
Course Title:
Course Developer:
Course Length (Hours):
PTSCTP Track:		Please Select		Please indicate if the course or activity applies to one or all tracks of the PTSCTP.

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Sheet 2: Agency Participants

Participant Status

Date Inactive (if applicable)

Reason Inactive (if applicable)

Last Name

First Name

Agency

Contractor Organization

Position

Email Address

PTSCTP Track

PTSCTP Enrollment Date

Required PTSCTP Completion Date

Required Refresher Training Completion Date

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please add additional agency employees and contractors below this line. FTA will issue these participants Individual Training Plans for the PTSCTP if they are not already enrolled.

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please Select Status

Please Select Status