+-----------------------------+----+------------+---------------------+
| **[Check                    | ## |            |                     |
| One:]{.underline}** User    | ## |            |                     |
| POC Alt POC                 |  G |            |                     |
|                             | ET |            |                     |
|                             | S/ |            |                     |
|                             | WP |            |                     |
|                             | S  |            |                     |
|                             | Re |            |                     |
|                             | qu |            |                     |
|                             | es |            |                     |
|                             | t  |            |                     |
|                             | Fo |            |                     |
|                             | rm |            |                     |
|                             |  D |            |                     |
|                             | at |            |                     |
|                             | e: |            |                     |
|                             |  1 |            |                     |
|                             | 2- |            |                     |
|                             | Oc |            |                     |
|                             | t- |            |                     |
|                             | 05 |            |                     |
+-----------------------------+----+------------+---------------------+
| ### [Requesting]{.underl    |    |            | **[US               |
| ine}: (select all that appl |    |            | Citi                |
| y):  GETS Card  WPS Service |    |            | zen:]{.underline}** |
|                             |    |            | Yes No              |
| Change POC/Alt POC Change   |    |            |                     |
| current information Reprint |    |            |                     |
| GETS Card                   |    |            |                     |
+-----------------------------+----+------------+---------------------+
| **For POC: Enter this       |    |            | **Fields in bold    |
| information online. Go to   |    |            | are required.**     |
| [http://gets.ncs            |    |            |                     |
| .gov](http://gets.ncs.gov/) |    |            | **Use Word to       |
| and follow the link for     |    |            | complete form. Do   |
| First Time GETS Requestor   |    |            | not press Enter.    |
| or Established GETS POC. If |    |            | Press Tab to        |
| web access is not           |    |            | advance to the next |
| available, or for more      |    |            | field. Spacebar     |
| information, call           |    |            | selects check       |
| 866-NCS-CALL (866-627-2255) |    |            | boxes.**            |
| or 703-760-CALL.**          |    |            |                     |
|                             |    |            |                     |
| **For others: Use this form |    |            |                     |
| to collect user information |    |            |                     |
| and forward to POC.**       |    |            |                     |
+-----------------------------+----+------------+---------------------+
| ### If you have a G         |    |            |                     |
| ETS card or were issued one |    |            |                     |
|  from stockpile, provide 1s |    |            |                     |
| t 8 digits:                 |    |            |                     |
+-----------------------------+----+------------+---------------------+
| **[O                        |    |            |                     |
| rganization:]{.underline}** |    |            |                     |
| (Acronym) **     ** Spell   |    |            |                     |
| out Organization: **     ** |    |            |                     |
|                             |    |            |                     |
| **[Subo                     |    |            |                     |
| rganization:]{.underline}** |    |            |                     |
| (Acronym) **     **         |    |            |                     |
|                             |    |            |                     |
| Spell out Suborganization:  |    |            |                     |
| **     **                   |    |            |                     |
+-----------------------------+----+------------+---------------------+
| **[Name]{.underline}**:     |    |            |                     |
| Name to appear on card      |    |            |                     |
| (GETS only): **     **      |    |            |                     |
|                             |    |            |                     |
| **     ** **     ** ** **   |    |            |                     |
| **           **             |    |            |                     |
|                             |    |            |                     |
| (Prefix) (First Name) (MI)  |    |            |                     |
| **(Last Name)** (Suffix)    |    |            |                     |
|                             |    |            |                     |
| Work Address: **     **     |    |            |                     |
|                             |    |            |                     |
| **     **                   |    |            |                     |
|                             |    |            |                     |
| City: **     ** State:      |    |            |                     |
| **  ** ZIP: **     **       |    |            |                     |
| Country: **     **          |    |            |                     |
+-----------------------------+----+------------+---------------------+
| **[NS/EP Title or           |    |            |                     |
| Function:]{.underline}**    |    |            |                     |
| **     **                   |    |            |                     |
+-----------------------------+----+------------+---------------------+
| **[Password]{.underline}**  |    |            |                     |
| (GETS only, 4-9             |    |            |                     |
| alphanumeric characters):   |    |            |                     |
| **     ** Allow             |    |            |                     |
| international calls: Yes No |    |            |                     |
|                             |    |            |                     |
| **Provide at least 1 phone  |    |            |                     |
| number and at least 1 other |    |            |                     |
| means of contact (phone,    |    |            |                     |
| e-mail, etc.).** POCs and   |    |            |                     |
| Alternate POCs must provide |    |            |                     |
| an e-mail address, as well  |    |            |                     |
| as a phone number for       |    |            |                     |
| contact outside of business |    |            |                     |
| hours.                      |    |            |                     |
|                             |    |            |                     |
| **[Primary Phone            |    |            |                     |
| #:]{.underline}** **     ** |    |            |                     |
| Secondary Phone #:          |    |            |                     |
| **     **                   |    |            |                     |
|                             |    |            |                     |
| Cellular #:**     ** After  |    |            |                     |
| Hours #: **     **          |    |            |                     |
|                             |    |            |                     |
| Pager #: **     ** Pager    |    |            |                     |
| PIN \# (if applicable):     |    |            |                     |
| **     **                   |    |            |                     |
|                             |    |            |                     |
| E-mail: **     ** Fax \#    |    |            |                     |
| (POC/Alt POC only):         |    |            |                     |
| **     **                   |    |            |                     |
+-----------------------------+----+------------+---------------------+
| **[Check the                |    |            |                     |
| category]{.underline}**     |    |            |                     |
| that best describes your    |    |            |                     |
| NS/EP mission. Descriptions |    |            |                     |
| appear on the accompanying  |    |            |                     |
| page.                       |    |            |                     |
|                             |    |            |                     |
| For **GETS**: (A) (B) (C)   |    |            |                     |
| (D) (E) For **WPS**: (A)    |    |            |                     |
| (B) (C) (D) (E)             |    |            |                     |
+-----------------------------+----+------------+---------------------+
| Optional: Indicate number   |    |            |                     |
| of GETS Stockpile Cards     |    |            |                     |
| requested (POC use only.    |    |            |                     |
| Minimize the quantity       |    |            |                     |
| requested): **   **         |    |            |                     |
+-----------------------------+----+------------+---------------------+
| #                           |    |            |                     |
| # [For WPS Requests Only]{. |    |            |                     |
| underline} Note: WPS is onl |    |            |                     |
| y authorized for [KEY]{.und |    |            |                     |
| erline} NS/EP leadership po |    |            |                     |
| sitions. Requestors must ha |    |            |                     |
| ve or be willing to subscri |    |            |                     |
| be to a service plan with a |    |            |                     |
| n authorized WPS provider.  |    |            |                     |
|                             |    |            |                     |
| **[Justification of need    |    |            |                     |
| for WPS:]{.underline}       |    |            |                     |
|      **                     |    |            |                     |
+-----------------------------+----+------------+---------------------+
| Requestors will be notified |    |            |                     |
| via E-mail of request       |    |            |                     |
| approval/disapproval.       |    |            |                     |
| Recommend you do not        |    |            |                     |
| acquire new cell service    |    |            |                     |
| for WPS until you receive   |    |            |                     |
| NCS approval. If not        |    |            |                     |
| provided now, the following |    |            |                     |
| details must be provided    |    |            |                     |
| later to initiate service:  |    |            |                     |
|                             |    |            |                     |
| Service Provider: **     ** |    |            |                     |
| Account #: **     **        |    |            |                     |
|                             |    |            |                     |
| WPS Phone #: **     **      |    |            |                     |
+-----------------------------+----+------------+---------------------+
| [**POC Name** (N/A if POC   |    |            |                     |
| Request):]{.underline}      |    |            |                     |
|                             |    |            |                     |
+-----------------------------+----+------------+---------------------+
| Previous versions obsolete  |    | GETS/WPS   |                     |
|                             |    | Request    |                     |
|                             |    | Form 26    |                     |
|                             |    | Sept 03-A  |                     |
+-----------------------------+----+------------+---------------------+