Waitlist Request -  Civilian Supervisor
Please use this form to submit waitlist requests for the Civilian Supervisor 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.

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 *
Email Address *
Method of Payment:
Include last 4-digits of credit card on file, if applicable
 *
Supervisor's FULL Name *
Supervisor's Email Address *
Indicate if the student is interested in dormitory-style onsite lodging:
Additional Notes/Comments (i.e. unavailability for certain program dates)
A copy of your responses will be emailed to the address you provided.
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