Rank / Name / SSN / Designator:



1. Name (Last, First, MI):

2. Rank / Last Four of SSN:

3. Current Duty Station:

4. Current Billet:

5. Date Reported (Month Year):

6. Designator (MOS) / Service:

7. Contact Info:

Work:

Mobile:

Fax:

Email:

8. AC / APC Member (Yes / No):

9. Chronology of Acquisition Experience.

• Examples provided in first two rows (Remove examples when submitting)

• List in REVERSE chronological order

• Dates must be in prescribed format

• Following the table, provide a narrative to demonstrate competency experience in functional area for each assignment (remove example when submitting)

|# |Dates |Activity |Title / Assignment |Functional |Months of Acquisition|Months of Program |

| |(YY/MM – YY/MM) | | |Competency |Time |Office Time |

| | | | |Demonstrated* | | |

|1 |06/03 – Pres |NADEP Jax |Production Officer |Production |24 |0 |

|2 |03/02 – 06/02 |PMA-263 |Class Desk |Engineering |36 |36 |

|3 | | | | | | |

|4 | | | | | | |

|5 | | | | | | |

| | | | | | | |

| | | | | | | |

| | | | | | | |

| |TOTAL: | |

| |1 |2 |3 | |

|Program Management (PM) | | | | |

|Test & Evaluation (TST) | | | | |

|Manufacturing and Production (PQM) | | | | |

|Logistics (LOG) | | | | |

|Systems Engineering (SPRDE) | | | | |

|Other: | | | | |

11. DAU Training.

• DAWIA requirements have changed over the years. Please fill in the table appropriately. Asterisked courses are the courses currently being offered by DAU.

|PM Course |Completed |Year Completed |

| |(Y/N) |(YYYY) |

| PMT - 301 | | |

| PMT - 302 | | |

| PMT - 303 | | |

|*PMT - 352 | | |

|*PMT - 401 | | |

|*PMT - 402 | | |

Explanation if Program Management (PM) Level III Career Field Certification was obtained by a method other than attending the above listed DAU courses:

______________________________

Signature (Required)

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Date

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