Uscg mmc Application Forms

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The U.S. Coast Guards expectation is that you disclose all current and past medical conditions on your 719K form. Reporting of medical conditions, including mental health, is likely not an excluding factor for licensure, however, not reporting them can have serious implications.
Un-united fractures, history of instability of a major joint, certain retained orthopedic fixation devices, severe scoliosis, or any condition that could interfere with daily participation in rigorous physical training or athletic programs, wearing of military equipment, or detract from military bearing and appearance
For anxiety disorders (for example, panic disorder), a person cannot enter the armed services if they needed any inpatient care, or outpatient care for more than 12 months cumulatively. They must not have needed any treatment for their anxiety disorder in the past 36 months.
E-mail Medical Certificate applications (CG 719K or K/E) to MEDAIP@uscg.mil. Put LAST NAMEFIRST NAMEMARINER REFERENCE NUMBER in the subject line of the email to MEDAIP@uscg.mil.
Psychiatric and Personality Disorders Any disorder or history of disorders with psychotic features. History of impulse control and conduct disorders. History of depression requiring medication, outpatient treatment or hospitalization. History of anxiety requiring medication, outpatient treatment or hospitalization.
Steps to Apply for an Original MMC Determine the Officer and/or Ratings that you wish to obtain by visiting the NMCs Checklist Page. Obtain a Transportation Workers Identification Credential. Fill out a CG-719B Application for Merchant Mariner Credential. (IF APPLICABLE) Fill out a CG-719C Conviction Statement.
The Application for Mariner Medical Certificate (Form CG-719K). This form is required for Officers and Mariners with a qualified rating. The Application for Merchant Mariner Medical Certificate for Entry Level Ratings (Form CG-719K/E). This form is required for entry level mariners.
Medications that may impair a mariners ability to perform routine and emergency duties are disqualifying. Central nervous system depressants (eg. opioids, benzodiazepenes, non-benzodiazepenes) are generally not waiverable. Agents that increase the likelihood of sudden incapacitation.