Playground Maintenance Technician Application November 8 – 9, 2016 Training Location: Puget Sound ESD 800 Oakesdale Ave SW Renton, WA 98057 Washington Schools Risk Management Pool (WSRMP) is proud to be offering a scholarship for members to attend the Playground Maintenance Technician Training. This two day training is specifically designed for maintenance and grounds staff who are responsible for inspecting, repairing and maintaining playground equipment. This training does not require any prior knowledge or training. Upon completion, attendees will receive a Playground Maintenance certificate from Eppley Institute for Parks & Public Lands at Indiana University. The scholarship includes the cost of registration and all necessary materials, a total value of $350. Your district will be reimbursed for these expenses after we verify attendance. However, the scholarship does not include release time or compensation for lodging, travel, and meals not provided. Scholarship winners must be employed by a member district on the dates of the program. A limited number of applicants will be selected, and may be restricted to one per district based on space availability. ELIGIBILITY CRITERIA— This scholarship is only available to a full-time employee of a member district whose duties include inspection, maintenance and/or installation of playground equipment for the district. Scholarship winners must be employed by a member district on the dates of the program. NAME OF APPLICANT: NAME OF DISTRICT: ________________________ JOB TITLE: PHONE: _________________________________ EMAIL: ____________________________________________________________________________________________ Which Risk Management/Safety functions do you fulfill? o Maintains playground equipment o Inspects playground equipment o Installs playground equipment o Other functions relating to school district playground equipment (please specify): _____________________________________________________________________________ Do you currently hold a CPSI certification (current or expired)? Yes No Will you be requesting CEU’s? Yes No A signed letter of recommendation by your supervisor must accompany this application. Submit the following to WSRMP: Return completed form no later than September 9, 2016 to: Washington Schools Risk Management Pool (WSRMP) PO Box 88700, Tukwila, WA 98138-2700 or Email/Fax to: (206) 394-9712/[email protected] Once your application is reviewed, you will receive notification of scholarship award and registration information. PART II - QUESTIONAIRE (Please check all that apply): SUBMIT APPLICATION: PART I – ELIGIBILITY CRITERIA PART III – SUPERVISOR RECOMMENDATION: 2016 Washington Schools Risk Management Pool