Waitlist Request - Basic Instructor 2023
Please use this form to submit waitlist requests for the 5-day Basic Instructor program. If you have any questions, please contact Katie.Johnson@maryland.gov. A copy of the request will be emailed to the address indicated below. 

*This form is only for the 5-day program!! If a student is interested in the 8-day, please login to register.*

NOTE: All requests must be completed by an agency contact listed as an authorized user in the MPCTC MDLE Portal. Otherwise the request will be denied and removed.

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Email *
Agency Information
Agency Name *
Agency Code *
Agency Contact/Training Coordinator LAST Name:
Must be listed as authorized user in MDLE
 *
Agency Contact/Training Coordinator FIRST Name: *
Student Information
Student Last Name *
Student First Name *
Certification Number *
Email Address *
Method of Payment:
Include last 4-digits of credit card on file, if applicable
 *
Supervisor's FULL Name *
Supervisor's Email Address *
Date(s) Preference / Comment on Availability *
Justification:
(2-3 sentence description of why the student requires the training; should include where the student will be teaching (academy or in-service) and how many hours per program.)
 *
Indicate if the student is interested in dormitory-style onsite lodging:
Additional Notes/Comments
A copy of your responses will be emailed to the address you provided.
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