Form Nscadm 001 - Cadet Application Request For Accommodation - U.s. Navy League Cadet Corps

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CADET APPLICATION

FOR OFFICIAL USE ONLY

U.S. NAVAL SEA CADET CORPS

U.S. NAVY LEAGUE CADET CORPS

REQUEST FOR ACCOMMODATION

INSTRUCTIONS

Complete this form ONLY when an accommodation is requested for a prospective cadet under the Americans with Disabilities Act

1. UNIT INFORMATION

1a. Unit Name

1b. Region

1c. Date of Request (DD MMM YY)

1d. Full Name and Rank of Commanding Officer

1e. Commanding Officer’s Phone Number

1f. Commanding Officer Email Address

2. CADET INFORMATION

2a. Last Name

2b. First Name

2c. Ml

2d. Age

2e. Parent/Guardian Names(s)

2f. Parent/Guardian(s) Phone Number

2g. Parent/Guardian(s) Email Address

3. ASSESSMENT (Completed by Parent/Guardian with assistance of the Unit Commanding Officer)

My Son/Daughter’s disability is (optional):

4. ACCOMMODATION

I am requesting the following accommodation for my son/daughter:

5. DETERMINATION

If Unit Commanding Officer determines accommodation is considered not reasonable, or cannot be made, Unit Commanding Officer must so state, with firm reasons and

further forward to the Regional Director for review/comment and NHQ Representative for final determination. Reason for not approving is:

6. ACCOMMODATION PLAN

If Unit Commanding Officer agrees, the plan of accommodation based on individual assessment to allow enrollment and participation, agreed to by all parties, is (be

specific as to can do’s, and can’t do’s, limitations, escorting requirements, Recruit Trainings and advanced training, and alternate activities/events, etc. Note: Plan can be

modified/adjusted/refined at any time.):

PREVIOUS EDITIONS ARE OBSOLETE

NSCADM 001 (Rev 08/14), Page 9

Formerly NSCADM 015