PA Wing Online CAP F17 - Application for SM Activities and Professional Development Courses
Use this PA Wing Online CAP F17 to reserve your seat.
* Required
1. Title of Activity
*
Name of Course - SLS, CLC, etc (& Group #)
2. Location of Activity
*
Name, City, ST
3. Dates of Activity/Course
*
MM/DD/YY - MM/DD/YY
4. Previously Attended This Activity?
Yes
No
Other:
5a. Last NAME
*
5b. First NAME
*
6. CAP Grade/Rank
SM, 2Lt, 1Lt, Capt, Maj, LtC, Col
SM
2Lt
1Lt
Capt
Maj
LtC
Col
Cadet
Other
7. CAPID #
*
8. Member's Address
*
Street, City, ST, ZIP
9a. Primary Phone
*
999-999-9999
9b. Secondary Phone
999-999-9999
9c. Your Email
10. Charter Number (NER-PA-999)
*
11. Unit Name (Squadron, Group, Wing, other)
*
12. Date and Method of Level 1 Completed
*
MM/YYYY
13. Date Joined CAP
*
MM/YYYY
14. CAP Duty Assignment and Inclusive Dates
Duty Role, MM/YYYY to MM/YYYY
15. CAP Aeronautical Rating
16. Specialties and Ratings Completed
Specialty Track - (None, Tech, SR, Master)
17. Previous Training Activities and Years Attended
Training, # years
18. Professional Development Awards
*
L1- Membership Award
L2- COP/Davis Award
L3- Loening Award
L4- Garber Award
L5- Wilson Award
19. Scholastic Achievement
High School
2-Yr College
4-Yr College
Post Graduate
20. Civilian Occupation
21. Emergency Medical Info
*
and Contact in Case of Emergency, NAME & PHONE
22. Outline Personal and Professional Goals in CAP
*
What do you want to achieve in CAP?
23. Remarks
24a. Your Unit Commanders NAME
*
(required) - Please advise your immediate Commander of your application for this Activity/Course
24b. Your Unit Commanders EMAIL
*
(required)
24c. Your Unit Commanders PHONE
*
(required)
25a. Your WING Commanders NAME
Complete only if required for Wing commander's approval (non-PA Wing members)
25b. Your WING Commanders EMAIL
Complete only if required for Wing commander's approval (non-PA Wing members)
25c. Your WING Commanders PHONE
Complete only if required for Wing commander's approval (non-PA Wing members)