Navy Medicine > Naval Medical Leader and Professional Development Command > Academic Programs > Additional Resources

Non-operational Course Nomination

Active Duty / Civilian Personnel

**Directions on How to Complete the Application**

Please do not omit any part of this application. Follow explanation of needed information in parentheses. Information not available should be indicated as “not available” (DO NOT LEAVE SPACES EMPTY). Fax all completed Facilitators and Tools applications to NMCOD Course Representative at: (301) 295-6085. Fax Completed Form to NMPDC: (301) 295-1292 / (DSN) 295-1292 or send as an E-mail attachment to: usn.bethesda.navmedprodevctrmd.list.nmpdc-academic-support@mail.mil

1. Course Title, Number, and Date Requested

2. Nominating Command and Address (provide full name of command and address)

3. Nominee Information:

Name (Last, First, MI)

Rate, Rank

PRD

EAOS

Designator,

Billet

NEC

Nominee's Duty Station Address (provide if different application number 2)

Nominee's UIC

Nominee's phone #

Nominee's Email address

(DSN and Commercial)

4. TAD Office Phone and Fax (Funding data will be sent to this number)

5. Nominee's Training Priority and Justification is as follows:

Command Priority: (Numeric listing of Command priority)

Justification: (The justification assists Program Managers in selection list and alternate list development. Include present and/or future positions and how nominee will utilize requested training. Stating that the “course is needed for promotion” is not an acceptable justification. This is not to be a listing of the nominee’s accomplishments. It is rather a statement of how the training will be an asset to the nominee and to the command).

6. POC for Questions about Information regarding this Nomination: ( Name, Rank, Position, Department, Phone Numbers, E-mail, and Fax)

7. The individual nominated is available for training and has full endorsement of the nominating command.

Signature of Endorsement: __________________________

Include Title: (Printed Name/Title, i.e; Head, Ed. and Training)

Required endorsement signature notes: XO, OIC, or DFA for PAC Course

Privacy Act

Authority to require this information is contained in 5 USC 301, Department Regulations. The principal purpose of the information on this application is to provide the training activity with certain information relative to your training needs and your location during training. Additionally, it may be used by employees of the Department of the Navy in the performance of their official duties related to the management, supervision, and administration of Navy personnel affairs and functions. Completion of this application is mandatory. Failure to provide required information may result in the denial of your request for training or duty assignment, or in other administrative action being taken.

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