CDROM Program Application:
Enrollment in this Program constitutes commitment to regular study. It is designed to be completed in 12 months. Extensions can be granted for valid operational or personal reasons but absent exceptional mitigating circumstances, total enrollment time cannot exceed 24 months, exclusive of times of voluntary disenrollment. Failure to make reasonable progress or to maintain and respond to communications with the Program Administrator after 60 days will result in involuntary disenrollment. Readmission to the Program under such circumstances will require a written request to the Director of the College of Distance Education.


The CDROM-based Program is open only to officers on sea duty or at remote duty stations without internet access.


Please fill out this application accurately and completely for proper consideration.

Rank

Last

First Name

Middle Initial

Suffix

SSN
 (digits only)

Date of Birth
  (MM/DD/YYYY)

Email Address

Mailing Address
 Note: All materials will be shipped to this address

2nd Address Line

3rd Address Line

City

State / Province

Postal Code
+ 4
 Zip Code +4  

Home Phone

Work Phone

Cell Phone


    required and     optional