ML23116A099
| ML23116A099 | |
| Person / Time | |
|---|---|
| Issue date: | 04/25/2023 |
| From: | NRC/NMSS/DMSST/ASPB |
| To: | |
| References | |
| Download: ML23116A099 (1) | |
Text
Revised: 07/25/2022 APPLICATION FOR NRC-SPONSORED TRAINING FOR AGREEMENT STATE STAFF Please complete and return to: AStrainingandtravel.Resource@nrc.gov.
If you have any questions or comments about this form, please contact Karen Meyer @ (301) 415-0113 SECTION I TO BE COMPLETED BY APPLICANT Name:
STATE:
E-Mail Address:
U.S. Citizen:
Yes No Business Phone/Ext:
COURSE/WORKSHOP INFORMATION Title of Course/Workshop:
Course Number:
Start Date:
End Date:
QUALIFICATIONS Currently qualified as a RAM Inspector: Yes No Currently qualified as a RAM License Reviewer: Yes No Student is being qualified as a: RAM Inspector and/or RAM License Reviewer Please specify: Medical Industrial Incident Response for Materials Events Academic Decommissioning Other:
Core Courses (Check Prior Training):
G-108 G-109 G-205 H-111 H-119 H-122L H-123 H-130L H-201 H-304 H-305 H-308 H-313 S-201 Non-Core Courses (Check Prior Training):
ACLW* F-104* G-116* H-111 H-115 H-119 H-120 H-121 H-312 H-314* H-315* H-408 H-410 H-411 H-412 H-413*
H-500
- CONSIDERED CORE FOR CERTAIN STATES On-Line Courses:
H-115S H-117S H-120S H-121S H-122S H-301S H-308S H-312S H-317S SECTION II TO BE COMPLETED BY THE STATE RADIATION CONTROL PROGRAM DIRECTOR Check if applicable:
- 1. The State is on heightened oversight or monitoring based on last IMPEP review:
- 2. The State currently does not have inspection or licensing expertise to maintain current IMPEP performance levels as demonstrated by one or more recent vacancies:
Please indicate the purpose of training:
Initial Qualification/Core Course:
(REQUIRED TO QUALIFY THE STUDENT AS A RAM INSPECTOR AND/OR RAM LICENSE REVIEWER)
Non-Core Course:
(NOT REQUIRED FOR INITIAL QUALIFICATION. PRIORITY WILL GENERALLY BE GIVEN TO STUDENTS WHO HAVE COMPLETED A MAJORITY OF CORE COURSES)
By submitting this application, you acknowledge that the student is currently being trained to be a qualified RAM Inspector and/or RAM Licensing Reviewer.
Radiation Control Program Director:
Phone #:
SIGNATURE:
If submitting more than one application for this course, indicate priority level:
Priority: of: (# of Apps.)