Course Information 1. Course: Select Course Boarding Officer Course Boarding Officer Practical Course Boarding Team Member Course Radiation Detection Level II Course Marine Patrol Officer - Instructor Marine Patrol Officer - Tactical Required - Select one Select the course the student will attend. 2. Convening Date: Required - example: 2/16/2007 Enter the date the course convenes. Example: 2/16/2007 Student Information 3. Full Name: Required - example: John P. Smith Student's full name. Example: John P. Smith 4. Grade/Rate: Required - example: BM2 The student's Grade or Rank. Civilian and international students should NOT abbreviate. Example: BM2 or Sergeant 5. Status: Select One Regular Active Duty Reservist International Student Civilian Law Enforcement Other Required - Choose one Select the student's current military status. 6. Email Address: Required - example: john.o.smith@uscg.com The student's e-mail address. USCG students shall enter their USCG email address. Example: john.o.smith@uscg.mil 7. Date of Birth: Required - example: 08/17/1980 Student's date of birth. Example: 08/17/1980 8. EMPLID: Optional - example: 1089999 Student's Employee Identification Number. Example: 1089999 9. Gender: Male Selection Required Female Select student's gender: Male or Female. Student's Medical Information 10. Drug Allergies: Please enter any drugs the student may have an allergic reaction to. Student's Unit Information 11. Unit Assigned: Required - example: Station Fort Lauderdale Unit or Agency the student is currently assigned. Example: USCG Station Fort Lauderdale. 12. Supervisor: Required - example: BMC Gene Gibson The name and title of the student's supervisor that can be contacted by the MLE Academy during normal work hours. Example: BMC Gene Gibson. 13. Phone number of supervisor: Required - example: 954-757-1234 The phone number to the person entered in block 10. Example: 954-757-1234 Student's Law Enforcement Experience 14. Number of boardings as a Boarding Officer: Required - example: 50 Number of years as a qualified Boarding Officer: Required - example: 5 Number of boardings as a Boarding Team Member: Required - example: 50 Number of years as a qualified Boarding Team Member: Required - example: 5 Number of Years in the USCG or in your Agency: Required - example: 10 Enter a number. Enter ' 0 ' if none. Additional Comments Additional Comments: Please enter any amplifying information about any blocks on this form. Please reference the block number you are commenting about. Example: Block #5: I am a Federal Correctional Officer. Submit Form
