Registration

  • Personnel Contact Information

Please note that fields in red font with an asterisk indicates a required field. Any non-required, black font, fields can be skipped.

  • First Name Middle Name Last Name
  • City State/Province Postal Code/Zip
  • Phone
    ###-###-####     Ext. Cell Phone
  • ###-###-####

  • What Program are you most interested in? This information is used to process your registration and does not restrict your ability to apply for other programs.

  •
  • Organization Information
  • City State/Province Postal Code/Zip
  • ###-###-#### Ext.
  • ###-###-####


  • All New Users are Required to Submit a COVA W-9 Form.
    Local Benefit
    1. When a political subdivision (a separate legal entity of a State that usually has specific governmental functions such as school districts, intrastate districts, local courts and other regional government entities etc.) has an active voice in the development and implementation of a particular program, and which has not had such active voice agrees in advance of implementation to the accept the benefits of the programs.
    2. Where no political subdivision has an active voice of a particular program but requests the benefits of the program as part of the local government’s highway safety program.

  •
Save Registration Information