Form Mt-2 - Qualification And Re-Certification printable pdf download

QUALIFICATION AND RE-CERTIFICATION

CCGD11N AUX

Form MT-2 (1-10)

Select Qualification or Re-Qualification: Basic, Instructor, Vessel Examiner, Marine Dealer

Member ID: _____________________________

Member Name: _________________________________________

BASIC QUALIFICATION (BQ)

I have completed one of the following Auxiliary courses by passing a closed book

exam or successfully challenging the exam:

Basic Skills and Seamanship (BS&S)

Sailing Fundamentals (SF)

Sailing and Seamanship (S&S)

About Boating Safely (ABS)

Boating Safely Course (BSC)

USPS Basic Boating Course

Member Signature: ____________________________________________________________________

INSTRUCTOR (IT) – INITIAL QUALIFICATION – Use ANSC Form 7014 (Attach Exam Answer Sheet)

INSTRUCTOR (IT) RE-CERTIFICATION

(Requires activity in past 5 years):Teach 2 hours or Assist for 4 hours)

Member ID

Member Name (Print)

Member Signature

IT Date

Assist Date

Hours

__________ ______________________ ____________________ _________ _________ ______

VESSEL EXAMINER (VE) – INITIAL QUALIFICATION -

Exam Score =________% (Attach Answer Sheet)

I certify that the above named member has completed the following VSC’s under my supervision:

(Total five (5) VSC’s to be completed by a Certified VE.)

Registration/

Member ID

Member Name (Print)

Member Signature

VSC Date

Documentation No.

___________ ___________________ _____________________ ____________ ______________

VESSEL EXAMINER (VE) – RE-CERTIFICATION

(Requires VE activity in past 5 years.)

I certify that the above named member has completed the following VSC’s under my supervision:

(Total two (2) VSC’s to be completed by a Certified VE.)

Registration/

Member ID

Member Name (Print)

Member Signature

VSC Date

Documentation No.

___________ ___________________ _____________________ ____________ ______________

PROGRAM VISITOR (PV) – INITIAL QUALIFICATION –

Exam Score = _______% (Attach Answer Sheet)

I certify that the above named member has completed the following PVs under my supervision:

(Total two (2) PVs to be completed by a Certified PV)

PROGRAM VISITOR (PV) – RE-CERTIFICATION

(Requires PV activity in past 5 years.)

I certify that the above named member has completed the following PV under my supervision:

(Total two (2) PVs to be completed by a Certified PV.)

Member ID

Member Name (Print)

Member Signature

PV Date

Location

__________ ___________________ _____________________ ____________ ______________

FC Member ID: _______________________ FC Name: ______________________________________

I have reviewed the pertinent documents and attest that the member named above has successfully completed all

requirements for qualification/re-certification as shown above. Attach exam answer sheets where applicable.

Signature of Flotilla Commander: ____________________________________________ Date: _____________

Submit to DIRAUX

Form Mt-2 - Qualification And Re-Certification

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