+-----------+------------+----------+----------------+----------------+
| ![](m     | # Ohio Win |          |                |                |
| edia/imag | g Civil Ai |          |                |                |
| e1.jpeg){ | r Patrol { |          |                |                |
| width="1. | #ohio-wing |          |                |                |
| 086111111 | -civil-air |          |                |                |
| 111111in" | -patrol .F |          |                |                |
| hei       | ormHeader} |          |                |                |
| ght="1.12 |            |          |                |                |
| 708333333 | # Applica  |          |                |                |
| 33334in"} | tion for   |          |                |                |
|           | {#applicat |          |                |                |
|           | ion-for .F |          |                |                |
|           | ormHeader} |          |                |                |
|           |            |          |                |                |
|           | # RA       |          |                |                |
|           | DIO OPERAT |          |                |                |
|           | OR AUTHORI |          |                |                |
|           | ZATION {#r |          |                |                |
|           | adio-opera |          |                |                |
|           | tor-author |          |                |                |
|           | ization .F |          |                |                |
|           | ormHeader} |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Last Name |            | First    |                | MI             |
|           |            | Name     |                |                |
|           |            |          |                |                |
|           |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Grade\    |            | CAPID\   |                | ROA Number\    |
|           |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Unit      |            | L        |                | Charter        |
| name\     |            | ocation\ |                | Number\        |
|           |            |          |                | GLR-OH-        |
+-----------+------------+----------+----------------+----------------+
| Ap        |            |          |                |                |
| plicant's |            |          |                |                |
| Address\  |            |          |                |                |
|           |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| City\     |            |          | State\         | Zip Code\      |
|           |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Home      |            |          | Other          |                |
| T         |            |          | Telephone      |                |
| elephone\ |            |          |                |                |
|           |            |          |    -   -       |                |
| -   -     |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Amateur   |            |          |                |                |
| Radio     |            |          |                |                |
| Call      |            |          |                |                |
| Sign:     |            |          |                |                |
|           |            |          |                |                |
| Rating:   |            |          |                |                |
|           |            |          |                |                |
|           |            |          |                |                |
| C         |            |          |                |                |
| ommercial |            |          |                |                |
| Radio     |            |          |                |                |
| Call      |            |          |                |                |
| Sign:     |            |          |                |                |
|           |            |          |                |                |
| Rating:   |            |          |                |                |
|           |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Select    |            |          |                |                |
| ap        |            |          |                |                |
| propriate |            |          |                |                |
| training  |            |          |                |                |
| completed |            |          |                |                |
|           |            |          |                |                |
| Basic     |            |          |                |                |
| Commu     |            |          |                |                |
| nications |            |          |                |                |
| Training  |            |          |                |                |
| IAW CAPR  |            |          |                |                |
| 100-1     |            |          |                |                |
|           |            |          |                |                |
| Advanced  |            |          |                |                |
| Commu     |            |          |                |                |
| nications |            |          |                |                |
| Training  |            |          |                |                |
| IAW CAPR  |            |          |                |                |
| 100-1     |            |          |                |                |
| (attach   |            |          |                |                |
| top       |            |          |                |                |
| portion   |            |          |                |                |
| of CAPF   |            |          |                |                |
| 23)       |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Applicant |            |          |                | Date           |
| (         |            |          |                |                |
| signature |            |          |                |                |
| and       |            |          |                |                |
| printed   |            |          |                |                |
| name)     |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Testing   |            |          |                | Date           |
| Officer/I |            |          |                |                |
| nstructor |            |          |                |                |
| (         |            |          |                |                |
| signature |            |          |                |                |
| and       |            |          |                |                |
| printed   |            |          |                |                |
| name)     |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Unit      |            |          |                | Date           |
| Commander |            |          |                |                |
| (         |            |          |                |                |
| signature |            |          |                |                |
| and       |            |          |                |                |
| printed   |            |          |                |                |
| name)     |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Wing      |            |          |                | Date           |
| Commu     |            |          |                |                |
| nications |            |          |                |                |
| Licensing |            |          |                |                |
| Officer   |            |          |                |                |
| (         |            |          |                |                |
| signature |            |          |                |                |
| and       |            |          |                |                |
| printed   |            |          |                |                |
| name)     |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| # INS     |            |          |                |                |
| TRUCTIONS |            |          |                |                |
+-----------+------------+----------+----------------+----------------+
| Submit    |            |          |                |                |
| request   |            |          |                |                |
| to Ohio   |            |          |                |                |
| Wing      |            |          |                |                |
| Hea       |            |          |                |                |
| dquarters |            |          |                |                |
| for       |            |          |                |                |
| approval. |            |          |                |                |
|           |            |          |                |                |
| Copy to   |            |          |                |                |
| be        |            |          |                |                |
| retained  |            |          |                |                |
| by        |            |          |                |                |
| Director  |            |          |                |                |
| of        |            |          |                |                |
| Commun    |            |          |                |                |
| ications/ |            |          |                |                |
| Licensing |            |          |                |                |
| Officer.  |            |          |                |                |
|           |            |          |                |                |
| Retain    |            |          |                |                |
| completed |            |          |                |                |
| original  |            |          |                |                |
| in        |            |          |                |                |
| Ind       |            |          |                |                |
| ividual's |            |          |                |                |
| Personnel |            |          |                |                |
| Record.   |            |          |                |                |
+-----------+------------+----------+----------------+----------------+

OWF-76 7 January 2009