SRTS Community of Practice - Interest Form Survey

1.Would you attend this community of practice?

Yes

No

2.Name:

3.Email Address:

4.Select the MnDOT District that corresponds with your work:

District 1: Aitkin, Carlton, Cook, Itasca, Koochiching, Lake, Pine, St. Louis counties

District 2: Beltrami, Clearwater, Hubbard, Kittson, Lake of the Woods, Marshall, Norman, Pennington, Polk, Red Lake, Roseau. D2 also serves the northern portion of Cass and the western portions of Itasca and Koochiching counties

District 3: Benton, Cass, Crow Wing, Isanti, Kanabec, Mille Lacs, Morrison, Sherburne, Stearns, Todd, Wadena and Wright counties

District 4: Becker, Big Stone, Clay, Douglas, Grant, Mahnomen, Otter Tail, Pope, Steven, Swift, Traverse and Wilkin counties

District 6: Dodge, Fillmore, Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, Wabasha and Winona counties

District 7: Blue Earth, Brown, Cottonwood, Faribault, Jackson, Le Sueur, Martin, Nicollet, Nobles, Rock, Sibley, Waseca and Watonwan counties

District 8: Chippewa, Kandiyohi, Lac qui Parle, Lincoln, Lyon, McLeod, Meeker, Murray, Pipestone, Redwood, Renville and Yellow Medicine counties

Metro District: Anoka, Carver, Chisago, Dakota, Hennepin, Ramsey, Scott and Washington counties

5.Please indicate any accommodations you need to fully participate in this event (e.g., dietary restrictions, accessibility needs, interpretation services, or other considerations).

Thank you for taking this survey!