Online AB Registration Form
This form must be completed for all students interested in registering for the Online AB Course. If you have any questions about completing this form, please contact the lead instructor at We look forward to having you in an upcoming cohort!
Email *
Student Information
We need to collect information to have on file for you as a student, as mandated by the USCG and so that we can communicate with you throughout the course.
Full name as you want it to read on course certificate of completion: *
Nickname or other names:
Last 4 digits of your Social Security Number (note: It will be necessary to provide your SS# for course registration):
Mailing address line 1, including street name and apartment number if applicable (where can we send you mail before and after the course?): *
Mailing address, city. *
Mailing address, state. *
Mailing address, zip code. *
Cell phone number: *
Preferred method of contact: *
An in-person exam is required for this course. We ask that you take the exam within 2 weeks of your course completion date. What locations would you be able to get to at the end of the course (check all that apply)? ***Special note: Due to the efforts to mitigate the spread of the COVID-19 virus, some of the locations may be subject to closure.*** *
Experience and Preparedness
We'd like to learn a little bit about your background so that we can best support you during this online course.
Approximately how many days of sea service have you earned up to this date? *
Do you plan to take a separate Lifeboatman course? *
Have you completed the shipboard assessments for Lifeboatman Limited? *
Do you have access to a laptop or tablet that supports Google Chrome's internet browser? *
Do you have reliable internet access? *
Have you ever taken an online class before? *
How did you hear about the Online AB course? *
If you have any questions or comments you would like to share with the lead instructor, please provide them here: *
Thank you!
Thanks for completing this form. We look forward to working with you as you work towards your AB!
Never submit passwords through Google Forms.
This form was created inside of The Seafarer Collective. Report Abuse