MA-937 Application for Review of Waiver/Deferment Decision

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U.S. De~artmentof Transportation
~ a r i t i m eAdministration

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APPLICATION FOR REVIEW OF WAIVEWDEFERMENT DECISION

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PART I. INSTRUCTIONS: Applicant must complete Part I. The completed form should be forwarded to:
Maritime Administration
Academies Program Officer
1200 New Jersey Avenue SE
Washington, DC 20590
The Maritime Administration will notify the applicant of the decision made on the request for review

1 2. Social Security Number

1. Name (Last, First, Middle)

3. Address (Street, City State, and Zip Code)

4. Is this an appeal of a disapproved waiver or deferment request?
waver

Deferment

5. Reason for Appeal

Date

6. Signature of Applicant

7. Recommendation

mpproved
D~sappmved

8. Remarks

9. Signature of Academies Program Ofticer

Date

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PART II.

12. Signature of Marltlme Admlnlstrator

MARITIME ADMINISTRATOR

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orrn MA-937 (Rev. 512008)

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