/

U.S. NAVAL SEA CADET CORPS

AMPHIBIOUS OPERATIONS TRAINING

APPLICATION
/

INSTRUCTIONS: 1. COMPLETELY FILL OUT THIS FORM 2. SEND THIS FORM AS WELL AS ALL REQUIRED SUPPLIMENTARY DOCUMENTATION TO COTC 3. FILE A COPY TO SERVICE RECORD

SECTION 1 – CADET PERSONAL INFORMATION

1a. Date (DD MMM YY)

/

1b. Unit Name

/

1c. Region

1d. Last Name / 1e. First Name / 1f. MI / 1g. Rate / 1h. Social Security Number
1i. Home Address / 1j. City / 1k. State / 1l. Zip Code +4
1m. Exp. Date / 1n. Date of Birth / 1o. Sex
o Male o Female / 1p. Home Phone / 1q. Hair Color / 1r. Eye Color / 1s. Height / 1t. Weight
1u. E-Mail Address / 1v. T-Shirt Size
o S o M o L o XL o XXL / 1w. Completed the Seaman Correspondence Course? o Yes o No / 1x. Completed the USCG Aux Safe Boating Course? o Yes o No

SECTION 2 – COMMANDING OFFICER INFORMATION

2a Last Name / 2b. First Name / 2c. Rank
2d.Home Address / 2e. City / 2f. State / 2g. Zip Code +4
2h. Daytime Phone / 2i. Evening Phone / 2j. E-Mail Address

SECTION 3 – Acknowledgement of Requirements

3. STATEMENT OF UNDERSTANDING BY INITIALING YOU CERTIFY YOUR UNDERSTANDING & CONSENT TO THE FOLLOWING PARAGRAPHS:
3a. I certify the applicant has taken NSCC Amphibious Operations Training Physical Fitness Test. I further certify the test has been taken within 2 months of application for this TWT. I or a member of my staff witnessed the test and the scores are listed below. /
Commanding Officer Initials
Push Ups (Number) / Sit ups (Number) / Pull ups (Number)or Flexed Arm Hang Time (Female Applicants Only) / Mile Run (Time)
3b. I certify the applicant has informed me of their ability to swim. I understand that if the applicant is unable to pass the 3rd Class Swimmer qualification on the first day of training, they will be sent home at the expense of the parent(s) or the home unit.
/ Commanding Officer Initials
3c. I certify the applicant has been given an enlisted efficiency evaluation in the last 3 months. Please complete the attached evaluation (PHIBOPS 003). /
Commanding Officer Initials
4. ENDORSEMENTS / THIS FORM WILL NOT BE PROCESSED WITHOUT REQUIRED ENDORSEMENTS
By endorsing this form you affirm the cadet, parents/guardians and the commanding officer are fully aware of the physical, academic and uniform requirements for this TWT as put forth in the Warning Order, located at www.Phibops.org. You further affirm the cadet is physically and mentally qualified to attend the requested training and that all information provided, to the best of your knowledge, is truthful and accurate; and you consent to the above listed NSCC/NLCC training and all terms and conditions of the preceding paragraphs. NOTE: DEPOSITS ARE NON-REFUNDABLE.
Applicant (Print or Type) / Signature / Date (DD MMM YY)
Parent (Print or Type) / Signature / Date (DD MMM YY)
Commanding Officer (Print of Type) / Signature / Date (DD MMM YY)
PHIBOPS 001 (REV 02/06) Previous versions are obsolete.