Capf 17 - Cap Members
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1
2APPLICATION FOR SENIOR MEMBER ACTIVITIES
Note: Use of this form is optional (see CAPR 50-17, para 2-7b2). See instructions on reverse.
1. Title of Activity
2. Location of Activity
(If applying for a position, include the position desired)
3. Dates of Activity
4. Previously Attended This Activity?
No
Yes (if yes, give date)
5. Last Name, First, Middle Initial
6. CAP Grade
7. CAPID
8. Member’s Address (Include No., Street, City, State, Zip)
9. Telephone (Include Area Code)
Work (
)
Home (
)
E-Mail
10. Charter Number
11. Unit Name
12. Date of Level I Completion
13. Date Joined CAP
14. CAP Duty Assignment and Inclusive Dates
15. CAP Aeronautical Rating
16. Specialties and Ratings Completed
17. Previous Training Activities and Years Attended
Specialty
Rating
a.
a.
b.
b.
c.
c.
d.
d.
e.
18. Professional Development Awards
19. Scholastic Achievement
a.
High School Graduate (Year):
b.
College (Number of Years):
c.
Post Graduate (Number of Years):
d.
20. Civilian Occupation
21. Emergency Medical Information
22. Outline Personal and Professional Goals in CAP
23. Remarks
Applicant’s Signature and Date
(Use Reverse Side or Attach Additional Sheet if Necessary)
24. Unit Commander (if required)
Unit Commander’s Signature and Date
Recommend
Approval
Disapproval
Remarks:
25. Wing Commander (if required)
Wing Commander’s Signature and Date
Recommend
Approval
Disapproval
Remarks:
26. Region Commander (if required)
Region Commander’s Signature and Date
Region
Selection Number
Recommend
Approval
Disapproval
Remarks:
CAP FORM 17, JUL 09
PREVIOUS EDITIONS WILL NOT BE USED AFTER 31 AUG 09
OPR/ROUTING: PD
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