Trident Program Enrollment Form
United States Coast Guard Auxiliary
8th District Western Rivers Region
Personal Information
Last Name, First, MI ______
Employee Number ______
District – Division - Flotilla ______
Email ______
Address ______
City, State, Zip ______
Phone – Office ______
Phone – Home ______
Phone – Mobile ______
Personal Ability Certification
I am best suited for:
Full Field Activity o
(Able to climb ladder on moving vessel)
Limited Field Activity o
(Able to walk around a land facility)
Watchstanding Activity o
(Able to work for 12 hours at a time
standing radio watch or desk work)
Desk Activity o
(Able to work for short periods at a desk)
Member Signature ______
Flotilla Commander Approval
I believe this member is able to perform to
ability listed above.
Flotilla Commander Signature ______
Date Completed
Security
DO or OS Personal Security
Investigation ______
SSI-NDA ______
Introductory Marine Safety Courses
Introduction to Marine Safety
(INTRO – MS/MEP) ______
Good Mate Manual and Course ______
Incident Command System Courses
ICS 100 ______
ICS 200 or 210 ______
ICS 300 (suggested) ______
IS 700 ______
IS 800 ______
Individual Development Plan
IDP Completed with DSO-MS ______
Safety Plan
Sector Safety Plan Signoff ______
Hazardous Materials Incident
Response (HMIR) – Awareness
(variety of courses accepted) ______
Date Completed
Marine Safety Administration and Management Specialist
AUX-MSAM Completion
(Two year AUX Officer service
requirement may be delayed) ______
Auxiliarist Visit to Prevention Department or MSD
Initial Visit ______
Computer Account Setup ______
MISLE Training ______
OMSEP Base Line
(if appropriate) ______
Area Field Guide Familiarization ______
Watch Quarter Station Bill ______
March 23, 2013 Page 1