ࡱ> [@ bjbj44 4ViVit^7^7^7^7|7,X9BT=T=T=T=HAK|LWWWWWWW$XYR[W}MEH}M}MWT=T=\XMMM}M T=T=WM}MWMBM5NQhqRT=9 |\^7M:-RR$rX0X=R4X\M(X\ qRJ$nhX\qR }M}MM}M}M}M}M}MWWM APPLICATION 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 (If applying for a position, include the position desired) 2. Location of Activity FORMTEXT   FORMTEXT      3. Dates of Activity4. Previously Attended This Activity? FORMTEXT       FORMCHECKBOX  No  FORMCHECKBOX  Yes (if yes, give date)  FORMTEXT       5. Last Name, First, Middle Initial6. CAP Grade7. CAPID FORMTEXT       FORMTEXT       FORMTEXT       8. Member s Address (Include No., Street, City, State, Zip) FORMTEXT       FORMTEXT       FORMTEXT      9. Telephone (Include Area Code)Work ( FORMTEXT     )  FORMTEXT      Home ( FORMTEXT     )  FORMTEXT      E-Mail  FORMTEXT       10. Charter Number11. Unit Name12. Date and Method of Level I Completion FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT      13. Date Joined CAP14. CAP Duty Assignment and Inclusive Dates15. CAP Aeronautical Rating FORMTEXT       FORMTEXT       FORMTEXT       16. Specialties and Ratings CompletedSpecialtyRatinga.  FORMTEXT       FORMTEXT      b.  FORMTEXT       FORMTEXT      c.  FORMTEXT       FORMTEXT      d.  FORMTEXT       FORMTEXT      17. Previous Training Activities and Years Attendeda.  FORMTEXT      b.  FORMTEXT      c.  FORMTEXT      d.  FORMTEXT      e.  FORMTEXT       18. Professional Development Awardsa.  FORMTEXT      b.  FORMTEXT       c.  FORMTEXT      d.  FORMTEXT      19. Scholastic AchievementHigh School Graduate (Year):  FORMTEXT        FORMTEXT      College (Number of Years):  FORMTEXT        FORMTEXT      Post Graduate (Number of Years):  FORMTEXT        FORMTEXT       20. Civilian Occupation21. Emergency Medical Information FORMTEXT       FORMTEXT      22. Outline Personal and Professional Goals in CAP FORMTEXT      23. Remarks (Use Reverse Side or Attach Additional Sheet if Necessary)Applicant s Signature and Date FORMTEXT      24. Unit Commander (if required) Unit Commander s Signature and DateRecommend  FORMCHECKBOX  Approval  FORMCHECKBOX  DisapprovalRemarks:  FORMTEXT      25. Wing Commander (if required) Wing Commander s Signature and DateRecommend  FORMCHECKBOX  Approval  FORMCHECKBOX  DisapprovalRemarks:  FORMTEXT      26. Region Commander (if required) Region Commander s Signature and DateRegion  FORMTEXT      Selection Number  FORMTEXT      Recommend  FORMCHECKBOX  Approval  FORMCHECKBOX  DisapprovalRemarks:  FORMTEXT      CAP FORM 17, MAR 03 PREVIOUS EDITIONS WILL NOT BE USED AFTER 30 JUN 03 OPR/ROUTING: ETP 27. Additional Remarks: FORMTEXT       INSTRUCTION FOR COMP)        * , . 0   " $ & ( V X Z ٳУٳГٳЋujhWUjTh`cUjhWUjhW5CJU\jhW5CJU\jh`c5CJU\jhW5CJU\hW5CJ\jhW5CJU\hW@CJhW@CJ hWCJhW.) . `'j`'j <$If h<$IfGkd$$Ifs04'4 sa<$If $ d<<a$. 0 \ TJkd4$$Ifs40'74 saf4 <$If h<$IfGkd$$Ifs04'4 saZ n p r | ~     $ & ( * > @ B L N P R f h j t v x z | ýýڠڠڠyqhW@CJ hW5\jhW5CJU\jhW5CJU\jh`c5CJU\j2hW5CJU\ hWCJhW$jhW5CJU\mHnHujhW5CJU\j<hW5CJU\hW5CJ\* ( P AZkd\$$IfsF4'    4 sa <$If h<$IfJkd$$Ifs40'74 saf4P x z | " R=j9kd\$$Ifs#dA4 sa<$If<Zkd$$IfsF4'    4 sa <$If     $ & ( < > @ J L P R T h j l v x | תךהׄpj hW5CJU\hWjhWCJUmHnHu hWCJj hW5CJU\j hW5CJU\jh`c5CJU\jhW5CJU\hW5CJ\jhW5CJU\$jhW5CJU\mHnHu'" $ N P z | ^=j^=jI^9kd $$Ifs#dA4 sa9kd$ $$Ifs#dA4 sa<$If9kd@ $$Ifs#dA4 sa (*/j^/jI^/j9kd $$IfsLadO4 sa9kd $$IfsLadO4 sa<$If9kdv $$IfsLadO4 sa$&*,468:NPRXZfh|~jln̢̼̼̲̒̂rjhW5CJU\jhW5CJU\j hW5CJU\j4 hW5CJU\hW hWCJjhWCJUmHnHuhW5CJ\jh`c5CJU\jhW5CJU\jU hW5CJU\,j <$If h<$If9kd$$IfsLadO4 sajl znnbb <$If h<$Ifkdh$$Ifs4F4'/x0    4 saf4    468BDFJsjhW5CJU\jhW5CJU\jhW5CJU\ hWCJhWjhW5CJU\jqhW5CJU\jh`c5CJU\jhW5CJU\jhW5CJU\hW5CJ\- 8znbb <$If h<$Ifkd]$$Ifs4F4'/x0    4 saf4F}qee <$If h<$Ifkdz$$IfsF'/ 0    4 saFHJ}um0<kd $$Ifs44 saf4<$If h<kd$$IfsF'/ 0    4 saJ  "&(<>@JLNPRfhjtvxz~гݠݐг݀гݠpгjHhW5CJU\jhW5CJU\jhW5CJU\$jhW5CJU\mHnHujh`c5CJU\j2hW5CJU\jhW5CJU\hW5CJ\jhWCJUmHnHuhW hWCJ,Nx jjG^ jjOkd$$Ifs40 g 4 saf4<$IfOkd~$$Ifs40 g 4 saf4 A$If^A$Ifxz4^W jjOkd^$$Ifs40 g 4 saf4<$IfOkd$$Ifs40 g 4 saf4 "$&0246̸̼̒o̸jhW5CJU\$jhW5CJU\mHnHujhW5CJU\ hWCJjhWCJUmHnHuhWjhW5CJU\hW5CJ\jh`c5CJU\jhW5CJU\jrhW5CJU\&46^j-<kd$$Ifs44 saf4<kd$$Ifs44 saf4<$IfOkd$$Ifs40 g 4 saf4  *,.8:<>BFH\^`jlnptx|~ȸ̢ȸ̒Ȳ̂ȸrj"hW5CJU\j!hW5CJU\j hW5CJU\j hW5CJU\ hWCJjhWCJUmHnHuhWhW5CJ\jh`c5CJU\jhW5CJU\j!hW5CJU\, <>np6j^6j}^@6j<kdF"$$Ifs44 saf4<kda!$$Ifs44 saf4<kd| $$Ifs44 saf4<$If"$&(,02FHJTVbdfjnpܲܢܒ܂j&hW5CJU\j%hW5CJU\j$hW5CJU\j$hW5CJU\jhWCJUmHnHu hWCJhWhW5CJ\jh`c5CJU\jhW5CJU\3&(X^x=j>^9kd~$$$Ifs#4 sa 9kd#$$Ifs#4 sa <$If h<<kd+#$$Ifs44 saf4XZ\^`bd=j^=j9kdF&$$Ifs#4 sa 9kdb%$$Ifs#4 sa <$If j^F<kd($$Ifs4#4 sa f49kd'$$Ifs#4 sa <$If9kd*'$$Ifs#4 sa BDXZ\fhjl  ^`tvxsj-+hW5CJU\j*hW5CJU\j)hW5CJU\j\)hW5CJU\jw(hW5CJU\jh`c5CJU\j(hW5CJU\hW5CJ\jhW5CJU\ hWCJhW-}@><kd,$$Ifs4#4 sa f4<kd+$$Ifs4#4 sa f4<$If<kdH*$$Ifs4#4 sa f4.02FHJTVXZnpr|~0  VXܲܢҚ܊j*1hW5CJU\hW@CJjV/hW5CJU\j-hW5CJU\j.-hW5CJU\ hWCJhWhW5CJ\jh`c5CJU\jhW5CJU\6.0X|rl$If h$Ifnkd,$$Ifs  0'0  4 sa<$If h<$If)^kd.$$Ifs4  '8(0  4 saf4<$Ifnkd.$$Ifs  0'0  4 sa&qkdi0$$Ifs4  04'0  4 saf4<$If^kd/$$Ifs4  '8(0  4 saf4Xy $ <$Ifqkd1$$Ifs4  04'0  4 saf4<$If.0w<$If  <$IfqkdS2$$Ifs4  04'0  4 saf4,.02DFZ\^hjnp68:RTprtĝvj7hWCJUj6hWCJUjh`c5CJU\j4hW5CJU\jhW5CJU\ hWCJhWhW5CJ\hW5CJ\j3hWCJUj3hWCJUjhWCJU hWCJ+02lny<$If <$Ifqkd3$$Ifs4  04'0  4 saf4npy<$If $ <$Ifqkd35$$Ifs4  04'0  4 saf4w<$If  <$Ifqkd5$$Ifs4  04'0  4 saf4y<$If <$Ifqkd7$$Ifs4  04'0  4 saf4dfhxz$&(@B^`bz|~̢̲Ȝxj<hWCJUj;<hWCJUjhWCJU hWCJj:hW5CJU\j<:hW5CJU\ hWCJhWhW5CJ\jh`c5CJU\jhW5CJU\jP8hW5CJU\+fy<$If $ <$Ifqkd8$$Ifs4  04'0  4 saf4fh}qi<$If <$If h<$If^hqkd{9$$Ifs4  04'0  4 saf4|~zld<$If  <$Ifkd,;$$Ifs4  F4'{,0      4 saf4~y<$If <$Ifqkd#=$$Ifs4  04'0  4 saf4v ,("&j6Lđڑ 8@BT¼Ƭ¥~wnw~w~w~w~w~w~w~ww~hW5@ CJ hW5CJ hWCJ\hW56@CJ]hW5@CJhW@CJ\U hW5\je@hW5CJU\ hWCJhWhW5CJ\$jhW5CJU\mHnHujhW5CJU\j=hW5CJU\+Nr|$If    $Ifqkd\>$$Ifs4  04'0  4 saf4rtv|Dj|D^ <<$If   qkd?$$Ifs4  0' !0  4 saf4++)`'^`kd@$$Ifl4N'8(064 laf4$Ifnkd?$$Ifl0'064 laLETION OF CAP FORM 17 NOTE: Use of this form is optional at the discretion of the activity director (see CAPR 50-17, para 2-7b2). See CAPR 50-17, CAP Senior Member Professional Development Program, for additional information and instructions. 1. APPLYING FOR ACTIVITIES: For region level activities, unit commander verifies the information, makes recommendation, signs the application, retains a copy, and forwards the original to wing headquarters. Wing commander verifies application, makes recommendation, signs the application, retains a copy, and forwards the original to region headquarters for final approval by region commander. For selected national level activities, unit commander verifies the information, makes recommendation, signs the application, retains a copy, and forwards the original to wing headquarters. Wing commander verifies application, makes recommendation, signs the application, retains a copy, and forwards the original to region headquarters for action (if applicable). Region commander makes recommendation, assigns selection number, signs the application, retains a copy, and forwards original to NHQ CAP/ETP. 2. COMPLETING THE FORM: Blocks 1-11, 13-15, 19-20 are self explanatory. Block 12. Enter the month and year and method of Level I completion. (Example: Feb 92/Seminar or Mar 93/ Mitchell Award.) Block 16. List each specialty and the highest rating completed in that specialty. (Example: Enter 213-2 for Emergency Services Officer - Senior Level, or enter 201-1 for Public Affairs - Technician Level.) Block 17. List names and dates of training activities such as SAR exercises, SLS, AFIADL Course-13, RSC, ACSC, AWC, etc. Use Additional Remarks section above or add additional sheet if necessary. Block 18. List training awards only along with completion dates. (Example: Garber Award Aug 90.) Block 21. List physical handicaps or ailments for which the applicant will be taking medication during the activity or which might affect the applicant s level of participation in activities. Provide a list of medication taken regularly. Use Additional Remarks section or add additional sheet if necessary. Block 24. For Unit Commander. Remarks are intended for consideration by the wing commander. Use Additional Remarks section or add additional sheet if necessary. Block 25. For Wing Commander. For National Staff College (NSC), wing commander approves for personnel assigned within their wing, then forwards to NHQ CAP/ETP. Use Additional Remarks section or add additional sheet if necessary. Block 26. For Region Commander. For National Staff College (NSC), this block is completed by region commander only for those members currently serving on the region staff, and then forwarded to NHQ CAP/ETP. Remarks are intended for consideration by National Headquarters. Use Additional Remarks section or add additional sheet if necessary. CAP FORM 17, MAR 03 REVERSE ,&846‘đ8@B`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v:`'v: & F & F h^`h$a$$xa$BTšĚ`'v:`'v:`'v:`'v:`'v:`'v:`'v: & FT$š hW5\ hWCJ\hW hW5CJ5 01h/ =!8"8#8$8%0`'H+ 01h/ =!8"8#8$8% P h5 01h/ =!8"8#8$8%0`'H' 01h/ =!8"8#8$8% P' 01h/ =!8"8#8$8% P# 01h/ =!8"8#8$8% 1h/ =!8"8#8$8%$$If!vh55#v#v:V s55/ / /  / 44 svDText54vDText55$$If!vh55#v#v:V s55/ /  / / 44 s$$If!vh575#v7#v:V s4575/  / / / 44 sf4vDText56tDCheck1tDeCheck2vDText53$$If!vh575#v7#v:V s4575/ / / /  44 sf4$$If!vh555#v#v#v:V s555/ /  / /  / / 44 svDText94vDText95vDText96$$If!vh555#v#v#v:V s555/ /  / / / 44 sl$$If!vh5##v#:V sdA5#/  44 savDText58l$$If!vh5##v#:V sdA5#/  44 savDText60l$$If!vh5##v#:V sdA5#/  44 savDText62l$$If!vh5##v#:V sdA5#/ 44 sag$$If!vh5#v:V sdO5/  44 savDText77vDText80g$$If!vh5#v:V sdO5/  44 savDText78vDText81g$$If!vh5#v:V sdO5/  44 savDText79g$$If!vh5#v:V sdO5/ 44 sa$$If!vh5/5x5#v/#vx#v:V s405/5x5/ /  / / / / / 44 sf4vDText64vDText65vDText66vDText67$$If!vh5/5x5#v/#vx#v:V s405/5x5/ / / / / / / 44 sf4#$$If!vh5/55 #v/#v#v :V s05/55 / /  / / / / / / 44 svDText68vDText69vDText70$$If!vh5/55 #v/#v#v :V s05/55 / /  / / / / 44 sr$$If!vh5#v:V s45/  44 saf4$$If!vh5g 5#vg #v:V s45g 5/  / / / 44 saf4vDText72vDText90$$If!vh5g 5#vg #v:V s45g 5/  / / / 44 saf4vDText88vDText91$$If!vh5g 5#vg #v:V s45g 5/  / / / 44 saf4vDText84vDText92$$If!vh5g 5#vg #v:V s45g 5/  / / / 44 saf4vDText85vDText93$$If!vh5g 5#vg #v:V s45g 5/  / / / 44 saf4m$$If!vh5#v:V s45/  44 saf4vDText73m$$If!vh5#v:V s45/  44 saf4vDText74m$$If!vh5#v:V s45/  44 saf4vDText89m$$If!vh5#v:V s45/  44 saf4vDText86m$$If!vh5#v:V s45/  44 saf4vDText87m$$If!vh5#v:V s45/  44 saf4l$$If!vh5##v#:V s5#/  44 sa vDText71l$$If!vh5##v#:V s5#/  44 sa vDText72l$$If!vh5##v#:V s5#/  44 sa vDText84l$$If!vh5##v#:V s5#/  44 sa vDText85l$$If!vh5##v#:V s5#/  44 sa g$$If !vh5##v#:V s5#/  44 sa vDText87vDText73m$$If !vh5##v#:V s45#/  44 sa f4vDText87vDText73m$$If !vh5##v#:V s45#/  44 sa f4vDText87vDText73m$$If !vh5##v#:V s45#/  44 sa f4m$$If !vh5##v#:V s45#/  44 sa f4$$If!vh55#v:V s0  5/  / 44 svDText75vDText76$$If!vh55#v:V s0  5/ 44 s$$If!vh58(#v8(:V s40  58(/  44 sf4vDText97$$If!vh58(#v8(:V s40  58(/  44 sf4$$If!vh55#v#v:V s40  55/  / 44 sf4vDText98$$If!vh55#v#v:V s40  55/ 44 sf4$$If!vh55#v#v:V s40  55/  / 44 sf4tDeCheck3tDeCheck4$$If!vh55#v#v:V s40  55/  / 44 sf4vDText99$$If!vh55#v#v:V s40  55/ 44 sf4$$If!vh55#v#v:V s40  55/  / 44 sf4tDeCheck3tDeCheck4$$If!vh55#v#v:V s40  55/  / 44 sf4xDText100$$If!vh55#v#v:V s40  55/ 44 sf4$$If!vh55#v#v:V s40  55/  / 44 sf4xDText102xDText103 $$If!vh5{5,5#v{#v,#v:V s40  5{5,5/ /  / /  / / 44 sf4tDeCheck3tDeCheck4$$If!vh55#v#v:V s40  55/  / 44 sf4xDText101$$If!vh55#v#v:V s40  55/ / 44 sf4$$If!vh5 5!#v #v!:V s40  5 5!/ / 44 sf4$$If!vh55#v:V l0654xDText104$$If!vh58(#v8(:V l4N0658(4f4R@R Normal*5CJOJQJ\^J_HaJmH sH tH D@D Heading 1$  <@&CJB@B Heading 2$$<@&a$CJ<@< Heading 3$@&5CJR@R Heading 4$$0v@&^0`va$CJ\DAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List 8>@8 Title$<<a$CJ>B@> Body Text  & F5CJBkX 7dĢz zBkX )2YZn,@ABKLijk   Mjk+@AYmn "#;<VWX}~9MN}0DEyz 0 T U   K L M j k l B C D a b c   MNIJ$%D  .ef0@00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 000000 0 0 0 0 0 0 0 00 0 00 0 00 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0  0  0  0  0 (0 0 0 0 0 0  0  0 00 0 0 0 0 0 0 0 0 0 0 000 0000000(0(0)2YZn,@ABKLijk   Mjk+@AYmn "#;<VWX}~9MN}0DEyz 0 T U   K L M j k l B C D a b c   MNIJ$%D  .ef000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 000000 0 0 0 0 0 0 0 00 0 00 0 00 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00  0  0  0  0  0 (0 0 0 0 0 0  0  0 00 0 0 0 0 0 0 0 0 0 0 0 00 000 00 00 (0(0 Z JT!$&(,.49>P. P " j Fx4X0nf~rB "#%')*+-/01235678:;<=?@ANOZfln~$*,8> ,07CIUagkw} #),8>EQWYekt '39BNT%179EKiu{}(.0<Bz a q }  - = V b h   $ 4 M Y _ FtFtFtG$G$FtFFFFtFtFtFFFFFFtFtFtFtFtFtFtFtFFFFFFFFtFtFFFFtFtFFFFtFFtFFtFtFtFFG$G$FG$G$FFFG$G$FF8@L(  NB  S DNB  S D/NB  S D 9NB  S DNB  S D#NB   S D8NB   S D NB   S DNB   S DNB   S DDNB  S DNB  S D NB  S D 5NB  S D NB  S D (NB  S D&NB  S D1NB  S D NB  S DNB  S D7NB  S DNB  S D0NB  S DYB S  ?L+no <=~ttt5at5atMytp t@tx tBtq t~ tAt9t xt !!t #{#t v t vtt,t - t t/Text54Text55Text56Check1Check2Text53Text94Text95Text96Text58Text60Text62Text77Text80Text78Text81Text79Text64Text65Text66Text67Text68Text69Text70Text72Text90Text88Text91Text84Text92Text85Text93Text73Text74Text89Text86Text87Text75Text76Text97Text98Text99Text100Text102Text103Text101Text104[o-!8Vl-FZu(C1{ W N   !"#$%&'()*+,-.m+?1Jh ~*?Xl!:U/C i ` L0C-::::Donald C KowalewskiPRIMARYDP,rv/ w, KMښreqI@h h^h`56CJ. @h v^v`56CJ. @h ^`56CJ. @h h^h`56CJ. h^`.h^`.hpLp^p`L.h@ @ ^@ `.h^`.hL^`L.h^`.h^`.hPLP^P`L.KMv/ DP,w,eq         `cW2YZn,@ABKLijk   Mjk+@AYmn "#;<VWX}~MN0DEyz 0 T U   K L M j k l B C D a b c """"""""""""""""""@ |   `@` ` ```````UnknownGz Times New Roman5Symbol3& z Arial"hTFTFxf * *$!8824dxx;QH(?W(APPLICATION FOR SENIOR MEMBER ACTIVITIESDonald C KowalewskiPRIMARY      Oh+'0( 8D ` l x )APPLICATION FOR SENIOR MEMBER ACTIVITIES WoPPLDonald C Kowalewskionaona capf017.dotPRIMARY2IMMicrosoft Word 10.0@G@Z3]l@(ܣ@(ܣ՜.+,0  hp  Civil Air PatrolO* x{ )APPLICATION FOR SENIOR MEMBER ACTIVITIES Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQSTUVWXYZ[\]^_`abcdefghijklmnopqrtuvwxyz{|}~Root Entry F`rData RfA1Tablesx\WordDocument4SummaryInformation(DocumentSummaryInformation8CompObjj  FMicrosoft Word Document MSWordDocWord.Document.89q