PLEASE NOTE: These appendices can be copied and pasted into MS Word documents.
I. Appendix I- Letter of Introduction
Dear Captain ____
I am in receipt of orders to USS AIRCRAFT CARRIER, to report in July of 200_ following completion of my residency in General Surgery at the National Naval Medical Center, Bethesda, MD.
I anticipate reporting aboard during the week of July 25th. I graduated from the State University Medical School in 200_. I am anxiously awaiting putting the last five years of residency training to work for you and your crew.
My wife, Sarah, will be accompanying me to the Norfolk area. She also works in the medical field and will be seeking employment at one of the many area hospitals.
My current contact information is…
I have visited your ship’s website and have seen pictures of where you have recently been. I am look forward with great anticipation to reporting aboard.Very Respectfully
Lieutenant Commander, US Navy
II. Appendix II- Board funding request
From: LCDR General Surgeon, MC, USNR, 123-45-6789/2015
To: Commander, Naval Medical Education and Training Command
8901 Wisconsin Ave, Bethesda, MD 20889
Via: Commanding Officer, USS NEVER DOCK
Subj: REQUEST FOR FUNDING OF CERTIFCATION EXAMINATION
Ref: (a) BUMEDINST 1500.18A
(b) NAVCOMPTMAN 0321061.
Per reference (a), I request funding to participate in the American Board of Surgery Certifying Exam as described below:
a. Location: City and State
b. Dates: Appropriate dates
c. Sponsor: American Board of Surgery
d. Exam fee: $675.00
e. Transport: Air
f. Government quarters are not available.
g. Government messing is not available.
2. I may be reached by at:
d. Local mailing address
3. I am not in receipt of release from active duty orders (RAD). I agree to remain on active duty for at least one year following the date of the certification examination. After the examination date, I have __ years of obligated service remaining.
4. If this request is not approved, I understand any advance payment of fees or related expenses from personal funds will be my responsibility.
5. I understand I shall comply with reference (b) by submitting a travel claim to my local personnel support detachment (PSD) within 5 calendar days of return from travel and personally forward a fully liquidated copy of the travel claim to NMETC Bethesda after PSD completes my liquidation.
6. I will forward a certified copy of the official results to BUMED (MED-52) and BUPERS (Pers-4415) via NMETC within 5 days of receipt.
LCDR, MC, USN
III. Appendix III- ISP Request
From: YOUR NAME, MC, USN, xxx-xx-xxxx/2100 (designator)
To: Chief, Bureau of Medicine and Surgery (BUMED-M1C1)
Via: Commanding Officer, USS EVERSAIL
Subj: ACTIVE DUTY AGREEMENT FOR MEDICAL INCENTIVE SPECIAL PAY (ISP)
Ref: (a) OPNAVINST 7220.171. Under reference (a), I hereby agree to remain on active duty for a period of 1 year from 1 October 2006 to 30 September 2007.2. Conditions of the agreement. I understand that:a. The 1 year of continuous active duty that I agree to serve will be effective on 1 October 2006.
b. ISP in the amount of $xx,xxx.00 with an effective date of 1 October 2006, may not be paid before approval of this agreement by Chief, Bureau of Medicine and Surgery (BUMED-M1C1). The amount indicated is based on my being fully privileged and practice in YOUR SPECIALTY.
c. This agreement may be terminated by the Chief, Bureau of Medicine and Surgery (BUMED-M1C1) for any reason enumerated in paragraph 13 of reference (a).
d. In the event of terminate, I must repay unearned special pay on a pro rata basis following paragraph 14 of reference (a).
e. Termination of ISP does not, in itself, relieve me of requirements to complete statutory and educational service requirements.
3. Unit identification code (UIC) _____, point of contact ______________, e-mail ____________________, and telephone number _______________.