US Coast Guard Auxiliary - District Nine - Western Region (9th Western)

HOME > MEMBERS > PUBLIC EDUCATION (PE) > NOTICE OF INTENT TO TEACH MEMBER TRAINING COURSE

Please fill in the information fields below. YOU MUST FILL IN THE FIELDS MARKED WITH AN *.

If you want to make changes to a class, do not submit a new form. Email the DSO-CS if you need changes made.

NOTE: These pages are intended to communicate with and disseminate information to Auxiliary members and are for informational purposes only. Do not contact the webmaster regarding these pages.

By listing a class here you are stating that the class is open to any Auxiliary member to attend. If the class is meant to be limited to a Flotilla or Division it should be sent directly to those Auxiliary members and not listed here. Any Auxiliary member wanting to attend a class should notify the contact person before attending the class.

Multiple Courses

Up to two courses may be entered with the same contact information. If you have more than two courses, upon submission of the first two, you will be given an opportunity to submit additional e-forms as needed. This information will be automatically forwarded by your ADSO-PE for publication on this website.

Please read the Special Note before submitting any course information.

NOTE: Items marked with an asterisk (*) are required.

COURSE 1

Course Name, select course* Course will be taught in (State), select state*

If the Course Name is WORKSHOP, select

If the Course Name is ICS, select

Course Location (i.e., City)* Address*

Start Date* Course Length (Number of Weeks)*

COURSE 2

Course Name, select Course will be taught in (State), select

If the Course Name is WORKSHOP, select

If the Course Name is ICS, select

Course Location (i.e., City) Address

Start Date Course Length (Number of Weeks)

COURSE CONTACT INFORMATION (Who should Be contacted regarding these courses)

First Name* Last Name*

Telephone* Email

Website

COURSE SPONSORED BY

Division Flotilla

MEMBER SUBMITTING INFORMATION (if different from Course Contact above)

First Name Last Name

Email

NOTE: It may take up to one week for your submission to be posted on the website, so please submit your intents as far in advance as possible.

SPECIAL NOTE: The disclosure of a member’s personal information is generally prohibited under the Privacy Act of 1974 UNLESS express permission is obtained from the member. All persons whose names and contact information are utilized in the connection with this form expressly authorize the dissemination and publication of the information to members of the general public. The person completing this form acknowledges that the appropriate permissions have been obtained. Enter the member’s name submitting the information and their division/flotilla number.