Instructions: Cadet MMC Application

Instructions:  Cadet MMC Application
Marine Engineering and Marine Transportation Majors
 

General Instructions:
Locate the CG-719B MMC application on our website, the same form is completed for both MENG and MTRA majors as well as students with a prior MMC and/or license. 

Printable PDF of the instructions

Note:

  • Forms will have some boxes pre-checked and some text boxes pre-filled.
  • The Coast Guard insists that our applicants type as much as possible on these forms. Illegible handwriting will slow down the process. Type as much as you can on the form. Put “none” or “n/a” in any blocks with no answers.
  • Once you’ve typed as many answers as you can into the form, print it out single-sided.
  • Sign and date the form in ink before turning it in.
  • Do not staple any pages together.       

SECTION I: Personal Data

1.  Complete Last, First, and Full Middle Name (do not use "nick name/slang")
2a .SSN (Social Security Number) if not in possession of a Merchant Mariner Credential (MMC). Leave this blank if you have an MMC.
2b. Reference number - If you have an MMC, fill in your Merchant Mariner Credential reference number.
3. Date of Birth
4. Citizenship/Nationality-Indicate if you are a US citizen or another country
5a. through 5e. To be completed.
6a. Home Address is your Home Address of Record, not the address of Massachusetts Maritime Academy
6b. Delivery/Mailing Address. If applicable
6c. Use your cell phone number as your primary phone number
6d. Not Applicable

6e. Enter your home telephone number.
6f.  Other - our school office fax: 508 - 830 - 6403
7a. Check box if next of Kin's address is same address in 6a; if not, enter address
7b. Include name with relationship of Next of Kin​

SECTION II: Requested Coast Guard Credential(s)

If you do NOT Currently hold an MMC, follow these instructions for section II:
In "Officer" row – leave blank
In "Qualified Rating" row – leave blank
In "STCW" row - Place an X in “Original”
In "Entry Level" row - Place an X in "Original”

If you currently hold an MMC or license, such as Master-100 tons, Mate-50 tons, etc, follow these instructions for Section II:
In “Officer” row – Place an Ex in “Raise of Grade”
In “Qualified Rating” row – leave blank
*
All cadets must apply for cadet Deck/Engine, ELR, BT, VPDSD, enrolled in 310 Program ratings in addition to your previously held license.

For both Engineer and Deck Majors, with or without a current MMC:
“Description of Endorsement(s) Desired” type in the following:
Cadet enrolled in 310 Program, ELR, BT,VPDSD
SECTION III: Safety and Suitability
1.  Leave blank.  You are not exempt from holding a valid TWIC
2.  Criminal Record.  Check boxes 2a. through 2f. with yes or no.  If you answer yes, to any question(s) in this section, you must complete a conviction statement using form CG-719C.
3.  Check the NDR - National Driver Registry box (this is mandatory)

 SECTION IV: Mariner's Consent/Certification
1.   Mariner Outreach System (MOS) must be checked with yes or no.
2.   For Continuity Renewal Only – If applies to you, be sure you understand
3.   Leave box #3 blank - all of you are over 18
4.   Certification.  Read and understand each statement because you are signing box 5. 
5.   Applicant’s Signature.  Sign your full name and date the application.
      The Mariner Credentialing staff will administer the oath and notarize your form.
6.   Third Party Release is not optional for students of the Academy
      a) Check boxes 6a. through 6d.
      b) Enter the following information:
          Massachusetts Maritime Academy as the Name of Organization
          Marie H. Huhnke, CDR - MMA, Director, Mariner Credentialing as POC
          101 Academy Drive, Buzzards Bay, MA  02532 as Street, City Address
         (508) 830 - 5071 as the Phone Number
**Save the form to your desk top, print out form, sign and date the form in ink - Full signature and current date.