Jump Start Train-the-Trainer Interest Form

Jump Start Train-the-Trainer Interest Form

Are you interested in scheduling a train-the-trainer bicycle safety education session, borrowing a bike fleet, or both?*

Select

Event requesting bike fleet

Date of event

Age range of potential bike users

Number of bikes requested

Name of person requesting bike fleet

Contact Email Address

Contact Phone Number

Is there any additional information that you'd like to share?

Name of Primary Contact*

Email Address*

School, School District, ESD, or Organization?*

Primary Contact Phone:*

Which trainings are you interested in?*

Check all that apply

Bicycle safety education

Pedestrian safety education

Approximately how many students will be receiving this programming?*

Select

Do you currently have supporters or advocates in the community for bicycle and pedestrian programming?*

If so, who are they?

Have relevant school administrators (superintendents, principals, etc) and PE teachers been briefed about the program, and are they supportive of this application?*

Select

How many participants would you anticipate will be attending the training?*

This can include participants like PE teachers, other school staff, and volunteers who will assist with your education program.

Describe the current SRTS programmatic efforts in your community.

Please list any grants, events, and programs you have had in the past three years.

Do you currently have a bike fleet in your community?*

Select

Would you like to have adaptive bikes at your training?*

Adaptive bikes are bikes designed to serve riders with different abilities that may keep them from riding a traditional bike. We will reach out to confirm your participants’ needs before the training to determine the type of adaptive bike best suited for their needs.

Select

Do you have students who will need adaptive equipment?

Select

Would you be willing to combine your training session with another community?*

Select

When would you like this training to occur? What dates would be most convenient for you (e.g. weekends)?*

Is there any additional information you would like us to know?

Privacy Notice|Report Abuse

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.