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MCQB2 2-12 
 Command Screening Checklist 
  
 
 
1. Purpose: To ensure Marines selected to attend MCQB2 are fully qualified. 
 
2. Information: In order to preclude Marines from being turned away upon 
arrival, it is necessary that parent commands ensure their Marines satisfy 
enrollment prerequisites set forth within this checklist. A failure to 
satisfy any of the prerequisites on the checklist disqualifies a Marine from 
attending the course. 
 
3. Action: The student will complete the Command Screening Checklist and 
attach copies of all certificates.  Students who fail to produce a Command 
Screening checklist with all appropriate signatures / printed names and 
attached certificates will not be permitted to begin training.  The Command 
Screening Checklist will be maintained in the Marine's student academic 
record. The checklist will be destroyed upon completion of TAD. 
 
4. Waivers: All waivers will be routed through the MSOR and must be received 
by the MSOS Operations officer no later than 30 days prior to the course 
convene date.  If a waiver is required, the Command Screening Checklist will 
be forwarded with the waiver request. 
 
 
Privacy Act Statement 
This Statement serves to inform you of the purpose of this data 
collection and to apprise how the collected data will be used. 
The Privacy Act System of Records Notice that allows for 
collection of this information is NM01500-2 DON EDUCATION AND 
TRAINING RECORDS located at 
http://www.privacy.navy.mil/privacy/noticenumber/NM01500-2.doc. 
Please read this Statement carefully. 
AUTHORITY: 10 U.S.C. § 5041, Headquarters U.S. Marine Corps, and 
E.O. 9397 (SSN) 
PRINCIPAL PURPOSE: Information is obtained to identify personnel 
who are assigned as students to course of instruction.  
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://www.defenselink.mil/privacy/dod_blanket_uses.html. 
RETENTION: Automated MCTIMS records are retained permanently. 
DISCLOSURE: Providing information on this form, including your 
Social Security Number, 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 
course of instruction you are requesting to attend 
 
 
 
 
 

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Last Name: Grade 
First Name: MI: 
SSN (last 4): Unit: 
MOS:  Contact Phone Number: 
MARSOC Deployments as CSO: 
Unit Location Year 
   
   
   
   
   
 
 
 
Training Information: 
Last Combat Marksmanship Pistol Qualification 
(must be within 12 months of course convene date) 
 
Date: 
 
Score: 
Last Combat Marksmanship Rifle Qualification 
(must be within 12 months of course convene date) 
 
Date: 
 
Score: 
 Date last Conducted CQB Sustainment   
(must be within 12 months of course convene date) 
 
Have you conducted CQB with Explosive 
Breaching? 
Yes No  
 
Are you a Breacher? 
 
Yes No  
Date of last Sustainment (__________) 
Prerequisites Yes No Signature and printed name of 
certifying personnel 
 
 
 
 
 
 
1 
 
 
 
Certified in 1000 level 
DA/WPNS events IAW NAVMC 
3500.97  
  Course Length in Training Days 
___________ 
 
Date Complete: 
 
Type of certification 
(circle one): 
-MARSOC ITC 
-Training Cell CQB Course 
-Special Missions CQB/DA 
Course 
-CQB Course for Branch of 
Service (specify course) 
2 GT Score of 110 or higher    
3 No alcohol abuse or 
disciplinary problems 
   

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4 
Certified by Commander to be a 
mature individual capable of 
supervising High Risk Training 
   
5 Secret Clearance verified  
JPAS 
   
6 
Medically qualified (current 
physical) to participate in a 
challenging combat physical 
training program. In Full Duty 
Status. 
   
 
 
 
 
7 Medical and Dental records in 
hand 
   
8 MARSOC Security Badge    
9 
Letter of Transmittal, current 
LTI/PFI for all serialized 
gear 
   
10 
Completed Marine Net Class 
SAT Overview (UT01AO) 
   
 
 
Date Complete: 
11 
Completed Marine Net Class 
BISC (BISC-010) 
   
 
 
Date Complete: 
12 
Completed Marine Net Class 
Range Safety (C1060120CA) 
   
 
 
Date Complete: 
 
 13 
 
Certified by Command as RSO 
   
 
Date last served as RSO:_________ 
 
14 
Student holds rank of SSgt or 
E6 at a minimum 
   
  
 15 
Student has been a CSO for 2 
years at a minimum 
   
 
16 
Student has deployed as a CSO 
for 180 days at a minimum 
   
 
17 
Student is currently holding 
the billet of assistant 
element leader or above 
   
 
18 
Meets minimum obligated 
service (1 year) upon 
completion of school. 
   
 
19 
Posses Uniforms and equipment 
listed in course gear list 
   
 
 

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___________________         ___________________       _________ 
Company Ops Chief         Signature           Date 
 
 
 
___________________         ___________________       _________ 
Company Commander           Signature                 Date 
 
 
 
___________________         ___________________       _________ 
Bn Ops Chief/O              Signature                 Date 
 
 
 
 
___________________         ___________________       _________ 
Bn CO/SgtMaj              Signature                 Date