ML23116A103
| ML23116A103 | |
| Person / Time | |
|---|---|
| Issue date: | 04/25/2023 |
| From: | NRC/NMSS/DMSST/ASPB |
| To: | |
| References | |
| Download: ML23116A103 (1) | |
Text
APPLICATION FOR NRC-SPONSORED TRAINING FOR MML PERSONNEL Please complete and return to: AStrainingandtravel.Resource@nrc.gov.
If you have any questions or comments about this form, please contact Karen Meyer at 301-415-0113 SECTION I TO BE COMPLETED BY APPLICANT Name:
STATE:
E-Mail Address:
U.S. Citizen:
Yes No Business Phone/Ext:
Name of Organization:
COURSE/WORKSHOP INFORMATION Title of Course/Workshop:
Course Number:
Location (City & State):
Start Date:
End Date:
QUALIFICATIONS
Title:
Description of current duties:
Check Prior NRC Training:
G-108 G-109 G-205 H-111 H-115 H-117 H-119 H-120 H-121 H-122L H-123 H-130L H-201 H-304 H-305 H-308 H-312 H-313 H-314 H-315 H-410 H-411 H-413 H-500 S-201 Check Prior NRC On-line Training:
H-115S H-117S H-120S H-121S H-122S H-130S H-301S H-308S H-312S H-317S SECTION II TO BE COMPLETED BY THE MML PROGRAM DIRECTOR Please provide a brief statement indicating why you want this individual to attend this course:
Please indicate the purpose of training:
Initial Qualification*:
If submitting more than one application for Cross-Training:
this course, indicate priority level:
Refresher Training:
Priority:
of:
(# of Apps.)
Other:
- Check Initial Qualification only if training is required to initially qualify the student as Inspector/License Reviewer as part of their current duties.
MML Control Program Director:
Phone #:
SIGNATURE:
Revised: 07/25/22