--- Page 1 --- Commanding Screening Checklist Maneuver Warfare Course PRIVACY ACT STATEMENT In accordance with the Privacy Act of 1974 (Public Law 93-579) this notice informs you of the purpose for collection of information on this form. Please read it before completing the form. Authority: 10 U.S.C. § 5013; 10 U.S.C. 5041; 10U.S.C. 1074f; 32 CFR 64.4; DoDD1215.13; DoDI 3001.02, CJCSM 3150.13B; DoDI 6490.03; MCMEDS; SECNAVINST 1770.3D; MCO 7220.50; E.O. 9397 (SSN); and SORN M01040 -3. Purpose: Information is obtained to identify personnel who are assigned as students to Maneuver Warfare Course (MWC), formerly Ground Combat Element Operations Specialist Course (GCEOS) . The collected information will be maintained in the Marine Corps Training Information Management System (MCTIMS) database. Routine Use: Information collected on this form may be shared outside the DoD for those specific purposes and listed organizations identified as DoD Blanket Routine Uses at http://dpcld.defense.gov/Privacy/SORNsIndex/Blanket-Routine-Uses/. Retention: Automated MCTIMS records are retained permanently. Disclosure: Providing information on this form is voluntary. Failure on your part, however, to answer all questions or any misrepresentation (by omission, concealment, or by misleading, false, or partial answers) may serve as a basis for denied assignment to the school you are requesting to attend. Information: Formal Courses are not screening institutions. In order to preclude students from being turned away upon arrival, it is necessary that parent commands ensure their Marines satisfy enrollment prerequisites set forth in NAVMC 1200.1_and this checklist. *Nominee is excused from all parent command duties and responsibilities and is unimpeded by appointments and existing family and/or financial hardships that may disrupt attendance. * Submission Instructions: Copies of this completed Command Screening Checklist and your Orders will be brought to Instructor staff on the day of arrival. A. Personal Information Rank Last Name First Name MI MOS Age Gender EDIPI Component: Active Reserve Unit B. Course Information Course Report Date: Course Grad Date: Location: EWTGPAC C. Prerequisites Item Yes No Remarks 1. Possess an active SECRET clearance. 2. Master Sergeant to Staff Sergeant. --- Page 2 --- 3. MOS: 0231, 0241, 0261, 0291, 0311, 0321, 0331, 0341, 0352, 0363, 0369, 0393, 0411, 0491, 0811, 0848, 0861, 1371, 1833 4. Attended the Marine Air Ground Task Force (MAGTF) Integrated Systems Training Center (MISTC) Watch Officer/ Watch Chief Course. 6. Nominee is excused from all parent command duties and responsibilities and is unimpeded by appointments and existing family and/or financial hardships that may disrupt attendance. D. Endorsements: Required Endorsements: The unit operations chief or senior enlisted advisor (SEA), and first O-3 Commander or above in the prospective student’s chain of command must endorse this command screening checklist. Approve Disapprove Rank and Name (Print) Signature Date Ops Chief (SEA) CO Point of Contact for this Command Screening Check list is: MSgt Derek Forte at (808) 436-2409 or Derek.L.Forte.mil@us.navy.mil GySgt Thomas Wortham at (443) 750-2619 or Thomas.S.Wortham.mil@us.navy.mil SSgt Shane Sweeney at (614)-406-0129 or Shane.A.Sweeney2.mil@us.navy.mil