Code of Federal Regulations Title 23. Highways 23 CFR Pt. 260, App. A—REQUEST FOR USE OF FEDERAL-AID HIGHWAY FUNDS FOR EDUCATION OR TRAINING (FORM FHWA–1422)

U.S. DEPARTMENT OF TRANSPORTATION

1. STATE

FEDERAL HIGHWAY ADMINISTRATION

REQUEST FOR USE OF FEDERAL-AID HIGHWAY FUNDS FOR

2. DATE OF REQUEST

EDUCATION OR TRAINING

(NATIONAL HIGHWAY INSTITUTE)

3. PROJECT NO.

4. NAME OF AGENCY SPONSORING COURSE

5. CO-SPONSOR (If any)

6. COURSE TITLE

7. DATE OF PROGRAM

8. ESTIMATED

7A. BEGINNING

7B. ENDING

ATTENDANCE

9. PURPOSE AND EDUCATIONAL OBJECTIVES OF THE PROGRAM (Be as Specific as Possible)

10. PROPOSED COURSE OUTLINE (Attach a copy of the course outline including a list of the subjects to be presented, the sequence of their presentation, the proposed speakers and the amount of time allotted to each subject. Also include the source material upon which the course is based, and the text books and collateral references to be used.)

11. PROPOSED COURSE SCHEDULE. (Provide information on the length of the course, including number of days, days of the week, and hours per day.)

12. TOTAL HOURS OF INSTRUCTION

13. CRITERIA FOR ELIGIBILITY OF PARTICIPANTS (Including organizational affiliation)

14. WHERE WILL COURSE BE HELD?

15. IS THIS PROGRAM A REPEAT OF A COURSE PREVIOUSLY GIVEN? (If yes fill-in 15A.)

15A. WHEN WAS IT LAST HELD?

☐ YES ☐ NO

16. IS THIS PROGRAM RECURRING? (If yes fill-in 16A.)

16A. GIVE FREQUENCY

☐ YES ☐ NO

☐ SEMESTER

☐ QUARTER

☐ OTHER (Specify)

17. NAME AND TITLE OF TECHNICAL DIRECTOR (Responsible for technical content.)

18. NAME AND TITLE OF COORDINATOR (Responsible for arrangements)

Form FHWA-1422 (Rev. 6-76)

PREVIOUS EDITIONS WILL NOT BE USED

19 ITEMS

AMOUNT

A.

TEXT BOOKS

$

B.

NOTEBOOKS AND SUPPLIES

$

C.

PRINTING

$

D.

COMMUNICATIONS

$

E.

SECRETARIAL

$

F.

AUDIO-VISUAL

$

G.

PHOTOGRAPHS

$

H.

BUSES

$

I.

MEETING ROOM RENTAL

$

J.

COSTS OF SPONSORING AGENCY'S STAFF TIME SPENT IN PREPARATION AND CONDUCT OF COURSE

$

K.

COSTS OF CO-SPONSOR'S STAFF TIME SPENT IN PREPARATION AND CONDUCT OF COURSE

$

L.

HONORARIA PAID TO OUTSIDE INSTRUCTOR

$

M.

INCIDENTALS

$

N.

OTHER ITEMS (Specify)

$

TOTAL ESTIMATED COSTS

(Excluding travel, subsistence and salaries of attendees)

$

20.

COST PER ATTENDEE

$

21.

AMOUNT TO BE PAID OUT OF 1/2 % FEDERAL-AID FUNDS

$

22.

REMARKS

REQUEST INITIATED BY (State Representative, Name and Title)

DATE

APPROVED (Division Administrator, Federal High way Administration)

DATE