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URI SCIENTIFIC DIVER APPLICATION
* required fields

*APPLICATION TYPE

Employees with diving as an element in their performance plan and/or position description.

Students with diving as an element in their performance plan and/or position description.

Visiting scientists with reciprocity who are EMPLOYED by a current AAUS organizational member institution.

Temporary divers who are NOT currently EMPLOYED by an AAUS organizational member institution.
DIVER INFORMATION
*Last
 *First
 MI
Address
Address 2
City
 State/Province
Zip
 Country
*Email Address
Work Phone
 Home Phone
 Cell Phone
 Fax Number
*Birth Month/Year (MM/YYYY)
Supervisor Name
 Supervisor Phone
 Supervisor Email
Affiliation
 Classification
Sponsoring Office

  		Dive Officer
EMERGENCY CONTACT INFORMATION
*Full Name
 Relationship
*Home Phone
 Work Phone
 Cell Phone
Address

 
DIVE INFORMATION/HISTORY
Scientific Diving Certifications
Certifying Organization
Certification Dates
to
mm/dd/yy
 Depth Certified

Other:
 

Dive Officer Name, Email, Phone #
Diving Specialties - Enter Date Certified
Science Diver
 Divemaster
 Full Face Mask
 Ice/Cave/Wreck
Drysuit
 Blue Water
Surface Supply
 Decompression
Nitrox
 Trimix
    
Dive Computer Training
Training Date

 mm/dd/yy		 Computer Type

Recreational Diving Certifications
Agency, Certification Level, Date, Location, Instructor & Instructor Number
Diving Activity
Total number of dives
 Total underwater hours
 Greatest depth
Cumulative total number of dives per depth to date:
0-30'
 31-60'
 61-100'
101-130'
 131-150'
 151-190'
Total dives in
last 12 months
 Date of last dive
  
     
*ACCESS INFORMATION
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