As Flotilla Commander, I certify that the below named member has satisfactorily met the requirements established in the Auxiliary Manual, COMDTINST M16790 (series) and is recommended for qualification or re-certification in the designated program.

For initial qualification the member has passed the qualifying examination on the date stated and has satisfactorily performed the supervised instruction, vessel exams or program visits in a training capacity as required for the program.

Date Member Passed Qualifying Exam:

Qualifying Test Score (90%+):

For re-certification the member has satisfactorily performed the supervised instruction, vessel exams or program visits in a training capacity as required for re-certification in the program.

Member Name:

Member Number:

Program - Please select one:

Instructor
Vessel Examiner
RBS Visitor

Action - Please select one:

Qualification
Recertification

Submitted by:

Flotilla Commander Name:

Division:

Flotilla:

Phone Number:

Email:

Member Number (of Submitting FC):

Additional Comments:

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