REQUEST FOR OPERATIONAL MISSION SPECIALTY QUALIFICATION CARD, CAP FORM 101, OR
SPECIALTY QUALIFICATION TRAINING CARD, CAP FORM 101T
NAME (LAST, FIRST, MI)

GRADE

CAPID

CHARTER NO.

ADDRESS (STREET, CITY, STATE, ZIP)

HOME TELEPHONE

WORK TELEPHONE

PAGE TELEPHONE

RADIO CALL

CAPF 76 (NO./DATE)

HEIGHT

WEIGHT

EYES

HAIR

BIRTHDATE (D,M,Y)

SENIOR CADET	APPLICATION FOR:

CAPF 101 CAPF 101T
EMERGENCY CONTACT NAME

PRIMARY PHONE

SECONDARY PHONE

FAA CERT. NO.

FAA MEDICAL (CLASS/DATE)

CAPF 5 DATE

CAPF 91 DATE

TOTAL HRS PIC

MOUNTAIN CLINIC

FAA CERT, RATINGS/LIMITATIONS

SPECIALTY RATING(S) REQUESTED	PLACE AN "X" OVER THE BLOCK

NO. FOR EACH REQUESTED RATING	INITIAL	UPGRADE
RENEWAL	TRANSFER
1	GENERAL EMERGENCY SERVICES	14	GROUND TEAM LEADER
2	INCIDENT COMMANDER	15	GROUND TEAM MEMBER
3	AGENCY LIAISON	16	URBAN DIRECTION FINDING TEAM
4	OPERATIONS SECTION CHIEF	17	INFORMATION OFFICER
5	PLANNING SECTION CHIEF	18	FLIGHT LINE SUPVERVISOR
6	LOGISTICS SECTION CHIEF	19	FLIGHT LINE MARSHALLER
7	FINANCE/ADMIN SECTION CHIEF	20	COMMUNICATIONS UNIT LEADER
8	AIR OPERATIONS BRANCH DIRECTOR	21	MISSION RADIO OPERATOR
9	GROUND BRANCH DIRECTOR	22	MISSION SAFETY OFFICER
10	SAR/DR MISSION PILOT	23	LIAISON OFFICER
11	TRANSPORT MISSION PILOT	24	MISSION CHAPLAIN
12	MISSION OBSERVER	25	MISSION STAFF ASSISTANT
13	MISSION SCANNER	26	RADIOLOGICAL MONITOR
27	TECHNICAL SPECIALIST (AS APPROVED BY WING/REGION COMMANDER)	SPECIALTY:

CAPT 116 COMPLETION DATE:	FIRST AID TRAINING / QUALIFICATION:

STANDARD	DATE EXPIRES:

STATE DRIVER'S LICENSE NO.

CAP DRIVER'S PERMIT (CAPF 75)	ADVANCED

EMT/EMICT/PARAMEDIC

CPR	DATE EXPIRES:
CAP MEMBERSHIP EXPIRES

PRESENT CAPF 101 EXPIRES	ATTACH SUPPORTING DOCUMENTATION IN ACCORDANCE WITH INSTRUCTIONS ON REVERSE.
I CERTIFY THAT ALL REQUIRED TRAINING HAS BEEN SATISFACTORILY COMPLETED AND THAT THE MEMBER IS QUALIFIED IN THE SPECIALTY AREAS INDICATED.
SIGNATURE OF REQUESTOR	DATE

TYPED NAME/GRADE OF REQUESTOR

SIGNATURE OF UNIT COMMANDER	DATE	ACTION NO.
SIGNATURE OF GROUP COMMANDER	DATE	ACTION NO.
SIGNATURE OF WING/REGION COMMANDER	DATE	ACTION NO.
CAP FORM 100, MAY 01	PREVIOUS EDITIONS WILL NOT BE USED AFTER 31 OCTOBER 2001	OPR/ROUTING: DOS

INSTRUCTIONS FOR COMPLETING CAPF 100

Initial qualifications and renewals:

For the general emergency services (ES) specialty, submit CAPF 100 along with one copy of the required supporting documentation to the unit commander for the unit commander's signature on the CAPF 101. Units will notify wing headquarters of issuances of CAPFs 101 with the general ES specialty.

For initial qualifications (other than the general ES specialty), submit CAPF 100 (original plus two copies) along with one copy of the required supporting documentation through the unit commander to the wing headquarters (or through the region DO to the region commander for region staff personnel in regions issuing specialty qualification cards).

For renewals other than Incident Commander and Agency Liaison, submit CAPF 100 along with one copy of the required supporting documentation to the unit commander for the unit commander's signature on the CAPF 101. Units will notify wing headquarters of CAPF 101 renewals.

For Incident Commander and Agency Liaison renewals, submit CAPF 100 (original plus two copies) along with one copy of the required supporting documentation through the unit commander to the wing headquarters (or through the region deputy chief of staff [DCS] for operations or emergency services as applicable to the region commander for region staff personnel in regions issuing specialty qualification cards).

Complete all applicable blocks, do not leave out requested information.

Indicate the specialty ratings or training areas (maximum of three training areas at any one time) requested.

Use a separate application for CAPF 101 and 101T. Do not combine specialty qualification, upgrade, and/or training requests on the same form.

Attach the following supporting documentation as applicable to the ratings (or training areas) requested:

All applications:

Copy of CAP Test 116 completion records (top of answer sheet) for initial application.

Evidence of prerequisite qualifications or training (copy of previously issued CAPF 101 [only if transferring from another wing], course completion certificate, etc.).

Evidence of satisfactory completion of required classroom instruction.

Required specialty training (copy of endorsed CAPF 101T indicating training received) (initial application for a particular specialty rating only).

Evidence of satisfactory completion of continuing education requirements (renewals of particular specialty ratings only).

Pilots:

Copy of current CAPF 5.

Copy of current CAPF 91 (SAR/DR mission pilot only).

Evidence of current FAA flight review (copy of logbook page or other record).

Ground Team Leaders and Members:

Copy of first aid (or equivalent) training certificate.

Evidence of satisfactory completion of bloodborne pathogen training (a minimum of two ground members/leaders on each ground must have this training).

CAP FORM 100, MAY 01	REVERSE

CAPF 100

PRIMARY

2004-02-03

CIVIL AIR PATROL