Coast Guard Credential Renewal Checklist
Use this form to confirm the information and documents needed to renew a Coast Guard credential.
Applicant Information
Full Name
*
First Name
Last Name
Preferred Contact Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing City/State
*
Preferred Contact Method
*
Please Select
Email
Phone
Credential Renewal Details
Credential Type Being Renewed
*
MMC
Endorsement
Other Credential Type
Credential Expiration Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Issuing Office or Region
Please Select
Northeast
Southeast
Great Lakes
West Coast
Gulf Coast
Alaska
Pacific Northwest
Other
Partial Credential Identifier (Last 4 Digits or Partial ID)
Renewal Type
*
First-Time Renewal
Routine Renewal
Checklist of Required Items
Current Credential Copy
*
Proof of Sea Service
*
Medical Certificate / Status Confirmed
*
Yes
No
Not Applicable
Drug Test Result Confirmed
Yes
No
Not Applicable
Approved Course Completion Certificates
Passport-Style Photo
Upload a File
Drag and drop files here
Choose a file
Cancel
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Eligibility and Readiness Verification
Sufficient recent sea service?
*
Yes
No
Meets medical fitness requirements?
*
Yes
No
Required training completed?
*
Yes
No
No unresolved issues that would block renewal?
*
Yes
No
Submission Status and Follow-up
Preferred Submission Method
*
Online
Email
In Person
Other
If Anything Is Missing, Preferred Follow-Up Action
*
Please Select
Email me
Call me
Send a text message
Hold until I respond
Other
Notes or Special Circumstances
Confirmation
*
I confirm that the information provided is complete and accurate to the best of my knowledge
Submit Checklist
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