U.S.

Navy Credentialing ProgramLast 4 of SSN: 7775

PROFESSIONAL
Name (Last, First, MI): WILLIAMS,CERTIFICATION
KRYSTAL, MARIE AND LICENSING VOUCHER REQUEST
PART
Command 3.Representative
Request for Certification
Email / License Exam Voucher
to: navycool@navy.mil
Name of Certification / License Exam you want funded (as found on COOL): New / First Time taking exam:
or Fax to: (850) 452-6897
(i.e. Certified Technical Trainer (CTT+) or Six Sigma Green Belt (SSGB))
Recert of credential in Part 2:
CERTIFIED IN HOMELAND SECURITY LEVEL I,PRIVACY
II, & III ACT STATEMENTMaint Fee of credential in Part 2:
(CHS-I. II, & III) Exam Re-Take (IA Workforce Only):
“For Official Use Only – Privacy Sensitive – Any misuse or unauthorized disclosure may result in civil or criminal
penalties.” Organization / Company (i.e. CompTIA):      
Credentialing
Testing Location
AUTHORITY: 10(i.e.
USCon-base
2015; overseas;
5 USC 301,off-base overseas and City/Country): ON-BASE
EO 9397.
Date you intend to take exam [let us know why if beyond 60 calendar days]: 15 SEPTEMBER 2010
PRINCIPAL PURPOSE(S): This record is used for reviewing, approving, accounting, and disbursing certification exam vouchers
submitted by Department of the Navy (DoN) personnel. The Social Security Number (SSN) is used to maintain a numerical
PART 4. Acknowledgments
identification filing system for filing and retrieving individual claims.
(Completed by applicant and verified by Command)
The command
ROUTINE approving
USE(S): officialare
Disclosures must verify member
permitted under 5isU.S.C. 552a(b),The credential
Privacy Act ofbeing
1974,sought is specifically identified
as amended.
currently working, and has experience, in the position for as Navy-funded on the Navy COOL website for the
DISCLOSURE: Voluntary; however, failure to furnish the information requested may result in denial of voucher request.
which the credential is tied to. member's rating, job or occupation. Identified with
* Command Approving Official must be Command IAM (for the icon.
PENALTY STATEMENT
IA vouchers), or Command Career Counselor, or E7 or above,
or DON Civil Service designated by the Commanding Officer.
Any person knowingly making false, fictitious, or fraudulent claims upon or against the United States
The member hasmay
Government reviewed the credentialing
be imprisoned foragency’s
up to fiveweb years (18 The USC member must1001,
287 and not haveand
received
31 USC exam3729).
funding
site and verified that he/she has met all the agency’s pre- from any other source that would constitute a
requisites, application requirements, education, and duplication of payment (such as GI Bill, local
PART 1. Employee
experience requirements to be eligibleInformation
for the exam. Command funding, or DANTES). This does not
FULL NAME (LAST FIRST MIDDLE) [ALL CAPS]: WILLIAMS, KRYSTAL, includeMARIE
personal loans or out-of-pocket payments.
Last 4 of SSN: 7775
The Navy’s Credentials Program
Military: Office must receive the The member shall have, at a minimum,
Civilian (Information Assurance workforce one year ONLY):
voucher request from the member or Command Approving remaining employment/service obligation.
Paygrade (i.e. E6, O3): E5 Pay Grade (i.e. GS-11):      
Official - NO LESS THAN seven (7) business days
Enlisted Rating (i.e. HM): BU Pay Schedule/Band (i.e. YA-2):      
PRIOR to the exam date.
Officer Designator (i.e. 1650):       Job Series (i.e. 0343):      
- Exceptions may be reviewed on a case-by-case basis.
If request is for a certification required IAW DOD 8570.1M – Information Assurance Workforce, please indicate your IA position
Under no circumstances shall the member (or member’s The member must report examination results (pass,
and IA Level (i.e. IAT-2) [you must be properly registered in TWMS]: IAT-      IAM-      CND-      IASAE-     
command/organization) register, take, participate in, fail) to Credentials Program Office within 30 calendar
If requesting
schedule, exam funding
or otherwise for athe
obligate credential
member that
or is NOT mapped to your rating,
days what other
of taking ratingIforpass,
the exam. occupation (as listed
also notify on Navy
Personnel
COOL SearchinPage)
Government are you performing
any Navy-funded credentialing in?      
duties program or Office to get entry into Service Record and provide
exam
Commandwithout
UIC:completed
N55752 and confirmed
Commandfunding
Name (from the68 NIMITZ): THIRTY-FIRST
i.e. CVN certification or SEABEE
license document
READINESS to Navy College(31ST SRG)
GROUP
Navy’s
ApplicantCredentials Program
Official “.mil” Office.
Email Address: krystal.williams@navy.mil Office for input to SMART/ETJ.
Duty Status (Check One): Office Phone: Fax:
PART 5. Certification andCountry
Active Duty:
Signature of Applicant
Code (if applicable):       Country Code (if applicable):      
* I agree to allow the Credentialing Provider and/or Testing Center to release my credentialing exam pass/fail results and/or
Reserve: FTS SELRES Com: (805) 982-5074 x-      Com: (   )    -     x-     
credentialing status to the Credentials Program Office.
* EAOS* (mm/dd/yyyy) : 07/18/2016      DSN: (312)551-5074 x-     
I will take the exam within 60 days & report pass/fail results to navycool@navy.mil DSN:    -    
withinx-     
30 days of the exam
* Military*members
I certify- that all statements
If EAOS is less thanin1 my
yearapplication are true
and you intend and correct to
to reenlist/extend, themust
you bestsubmit
of my aknowledge and belief.
Special Request Chit or other
official documentation approved by your chain of command,
Full Name of Applicant (Printed): WILLIAMS, KRYSTAL, MARIE reflecting your intent to reenlist/extend. Submit/fax your approved
Special Request Chit/official documentation along with this voucher request form.
Signature of Applicant: Date Signed (mm/dd/yyyy):      

PART 2. Command
PART 6. Certification / License
Approval History
(Completed by Local Command Approving Official)
Professional ICertifications / Licenses
certify applicant Held (List):
was counseled Date for
and determined eligible Awarded Expiration
the stated credentialing Date (mm/dd/yyyy)
examination.
(mm/dd/yyyy)
I have reviewed this form and applicant meets prerequisites, EAOS, and credential requirements stated in PART 4 above.
     
(1)As Command Approving Official, I will ensure Applicant       reports exam results within     
90 days of my signature
(2)                  
Approved Voucher Request Disapproved Voucher Request
(3)                  
Full Name (Last, First MI): MARTENS, ERIC, L. Phone Number: (805) 982-4228 x-     
(4)                  
Signature:       Date (mm/dd/yyyy):      
Rank or Office Title: LT/OPERATIONS OFFICER R3 Official Email Address: eric.martens@navy.mil
If application is e-mailed from an official .mil email address, no signatures are required, but email must come from Command
Approving Official . If faxed/scanned, Parts 5 & 6 must be signed.

1 Form Date: 15 Jul 2010

Credentials Program Office contact information:

U.S. Navy Credentials Program Office

Center for Information Dominance
Corry Station, Bldg 502 Rm 104E
Pensacola, FL 32511

Voice Comm: (850) 452-6683, 6664, 6324, 6287

Voice DSN: 922-6683, 6664, 6324, 6287
Fax Comm: (850) 452-6897
Fax DSN: 922-6897

Email: navycool@navy.mil

Office Hours: Monday – Friday 0700-1600 (central time zone)

Voucher Request tips:

- Send in 1 voucher request form for each certification (if the certification requires multiple exams,
indicate this in Part 3)

- Ensure form Parts 1 through 6 are complete – Command Approving Official must verify entire form

- Ensure your email address is correct and is a “.mil” email address (this is how we will communicate
your exam payment to you)

- Ensure EAOS reflects a minimum of 1 year remaining in-service.

* Military members - If EAOS is less than 1 year and you intend to reenlist/extend, you must
submit a special request or other official documentation approved by your chain of command,
reflecting your intent to reenlist/ extend. Submit/fax your completed Special Request Chit /
docs along with this voucher request form. Wording on request chit can be something like:

“Respectfully request to participate in Navy-funded credentialing program. I intend to reenlist/extend to

meet EAOS requirement”

- Emailed forms must come from Command Approving Official’s .mil email address (this is our way to
validate that the request is approved and from a trusted source)

- In most cases, you must schedule and take the credential exam within 60 calendar days from
acceptance of your application. If your certification/license exam process takes longer than 60 days
please call or email the Navy’s Credentials Program Office so we can make a note in your record.
Vouchers not used in the timeframe you have coordinated with us will be recalled and you will no longer
be authorized to use the voucher. A time waiver for going beyond 60 calendar days can be done, but
we do this on a case-by-case basis.

IMPORTANT NOTE – If the Navy’s Credentials Program is expected to fund the credentialing exam –
Under no circumstances shall the member (or member’s command/organization) register, take, participate in,
schedule, or otherwise obligate the member or Government in any Navy-funded credentialing program or exam
without completed and confirmed funding from the Navy’s Credentials Program Office.

2 Form Date: 15 Jul 2010