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Freight Peer to Peer Exchange Application

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  1. Applicant Information:

Name of Organization:

Contact Name:

Address:

Phone:

Fax:

E-mail:

Date of Application Submission:

 

  1. Identify the proposed peer exchange topic and the needs and issues to be addressed.

 

  1. Identify the proposed date and location of the exchange. (Applications must be submitted at least one (1) month in advance of the proposed exchange to allow sufficient time for travel processing and administration). Emergency requests will be addressed on an as needed basis.

 

  1. Describe briefly the importance of the planning issue with respect to regional or statewide goals.

 

  1. Describe how your agency will use the information disseminated from the Peer Exchange.

 

  1. Describe how the requested technical assistance will be beneficial to the region or state.

 

  1. Will you need a facilitator?

____ Yes

____ No

 

  1. If yes, briefly state how the facilitator will benefit the peer technical assistance exchange, if there is a specific facilitator requested, please provide the specific qualifications of the facilitator. The Program Coordinator may also assist with locating an appropriate facilitator.

 

  1. The technical assistance requested (check one):

___ Peer Work Session

___ Peer Roundtable

 

  1. Describe how the results of the exchange will be used and evaluated.

 

  1. List the proposed Peer experts/participants of the Peer Exchange. List the name of the individual(s) or organizations that may participate and include their organization, city and state. If assistance is needed in finding an appropriate peer(s), please state such below and the Program Coordinator will assist with locating a knowledgeable expert. Be aware that not all Peers may be available or appropriate to your needs, and that the Program Coordinator may suggest alternate or additional Peers to meet your needs.

 


Please note: Organizations requesting a peer event are required to submit a report to FHWA summarizing the meeting, including outcomes and future actions. A report template will be provided. The report is due to FHWA within 45 days of the peer event.

____ Yes, I agree to submit a report to FHWA within 45 days of the peer event using the supplied report template.

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