NCVEC QUICK-FORM 605 APPLICATION AMATEUR …

1 NCVEC QUICK-FORM 605 APPLICATIONAMATEUR operator / primary station LICENSESECTION 1 - TO BE COMPLETED BY APPLICANTPRINT LAST NAMESUFFIX (Jr., Sr.)FIRST CALL SIGN (IF LICENSED)MAILING ADDRESS (Number and Street or Box)FEDERAL REGISTRATION NUMBER (FRN) - IF NONE,THEN SOCIAL SECURITY NUMBER (SSN)CITYSTATE CODEZIP CODE (5 or 9 Numbers)DAYTIME TELEPHONE NUMBER (Include Area Code)E-MAIL ADDRESS (MANDATORYTO RECEIVE LICENSENOTIFICATIONEMAILFROM FCC)Basic QualificationQuestion:Has the Applicant or any party to this APPLICATION , or any party directly or indirectly controlling the Applicant, ever been convicted of afelony by any state or federal court?YESNOIf YES , see FCC BASIC QUALIFICATION QUESTION INSTRUCTIONS AND PROCEDURES on the back of this HEREBY APPLY FOR(Make an X in the appropriate box(es)):EXAMINATIONfor a new license grantEXAMINATION forupgradeof my license classCHANGE mynameon my license to my new nameFormer Name:(Last name) (Suffix)(First name)(MI)CHANGEmy mailing address toaboveaddressCHANGEmy stationcall signsystematicallyApplicant s Initials: To ConfirmRENEWALof my license grantExp.

2 Date:Do you have another license APPLICATION on filewith the FCC which has not been acted upon?PURPOSE OF OTHER APPLICATIONPENDING FILE NUMBER (FOR VEC USE ONLY)I certify that: I waive any claim to the use of any particular frequency regardless of prior use by license or otherwise; All statements and attachments are true, complete and correct to the best of my knowledge and belief and are made in good faith; I am not a representative of a foreign government; Iam not subject to a denial of Federal benefits pursuant to Section 5301of the Anti-Drug Abuse Act of 1988, 21 862; The construction of my station will NOT be an action which is likely to have a significant environmental effect (See 47 CFR Sections and Section (a)); I have read and WILL COMPLY with Section (c) of the Commission s Rules regarding RADIOFREQUENCY (RF) RADIATION SAFETY and the AMATEUR service sectionof OST/OET Bulletin # is qualified for operator license class:NO NEW license OR UPGRADE WAS EARNEDTECHNICIANE lement 2 GENERALE lements 2 and 3 AMATEUR EXTRAE lements 2, 3 and 4I CERTIFY THAT I HAVE COMPLIED WITH THE ADMINISTERING VE REQUIRMENTS IN PART 97 OF THECOMMISSION S RULES AND WITH THE INSTRUCTIONS PROVIDED BY THE COORDINATING VEC AND THE VEs NAME (Print First, MI,Last, Suffix)VEs station CALL SIGNVEs SIGNATURE (Must match name)DATE SIGNED2nd VEs NAME (Print First, MI, Last, Suffix)VEs station CALL SIGNVEs SIGNATURE (Must match name)DATE SIGNED3rd VEs NAME (Print First, MI, Last, Suffix)VEs station CALL SIGNVEs SIGNATURE (Must match name)DATE SIGNEDDO NOT SEND THIS form TO FCC THIS IS NOT AN FCC THIS form IS SENT TO FCC, FCC WILL RETURN IT TO YOU WITHOUT form 605 - September 2017 FOR VE/VEC USE ONLY - Page 1 Signature of Applicant:XDate Signed.

3 SECTION 2 - TO BE COMPLETED BY ALL ADMINISTERING VEsDATE OF EXAMINATION SESSIONEXAMINATION SESSION LOCATIONVEC ORGANIZATIONVEC RECEIPT DATEAMATEUR RADIO LICENSES AND REQUIREMENTSIn the US, there are three AMATEUR Radio license levels, orlicense classes which are Technician, General and AmateurExtra. The Federal Communications Commission (FCC) grantsthese licenses. The exams cover regulations, operatingpractices, and electronics theory. They are based oncumulative knowledge and build off one another. FCC requiresthe lower level exams to be passed for the higher levellicenses to be 1:Technician ClassEXAM: 35 question Technician Written Exam (Element 2)LEVEL 2:General Class(upgrade from Technician)EXAM: 35 question General Written Exam (Element 3)LEVEL 3: AMATEUR Extra Class(upgrade from General)EXAM: 50 question Extra Written Exam (Element 4)The written examinations are constructed from question poolsthat have been made public. There is no exemptionfrom thewritten exam requirements for persons with difficulty in reading,writing, or because of a handicap or disability.

4 There are examaccommodations that can be afforded examinees. To view thequestion pools and other useful information or to contact anFCC appointed VEC organization, CONTACT INFORMATIONS hould you have any questions, please contact the FCC at877-480-3201 (weekdays), or visit the FCC website SECURITY NUMBERU nder the Debt Collection Act of 1996 your Taxpayer IDNumber (TIN), which is your Social Security Number, isrequired on this APPLICATION -- or your FCC-assigned FederalRegistration Number (FRN). An FRN is assigned by the FCCregistration system as soon as your SSN is FCC CORES FRN Registration form 605 The NCVEC form 605 is for VE / VEC use only. Do not sendor provide this form to the FCC. This form is used at a VEexam session to apply for a new or upgrade AMATEUR RadioOperator/ primary station license . It may also be used to renewor update your license (change your mailing address, emailaddress, name, etc.). This form may not be used to apply for anew specific Vanity station call FCC APPLICATION form 605 The FCC form 605 may not be submitted to a VE examsession team or a VEC since it does not request theinformation required by the administering VEs.

5 The FCC Form605 may be used to renew or modify your license . New vanitylicense requests and sequential call sign changes require anFCC schedule D form in addition to the FCC 605 form . Sendthe FCC 605 form to: FCC, 1270 Fairfield Rd., Gettysburg PA17325-7245. You may file license renewals or changes onlinedirectly with the FCC form 605 FOR VE / VEC USE ONLYS eptember 2017 - Page 2 FCC BASIC QUALIFICATION QUESTIONThis item enables the FCC to determine whether an Applicantis eligible under 310(d) and 308(b) of the CommunicationsAct of 1934, as amended, to hold or have ownership interest ina station license . Applicants are required to answer thequestion only if 1) they are filing NCVEC or FCC form 605 forone of the following purposes indicated:New, Amendment,Modification (Upgrade or Call sign change), orRenewal/Modification; and 2) the answer has changed fromthe answer previously provided. Applicants using NCVEC orFCC form 605 for any other purpose are not required toanswer this BASIC QUALIFICATION QUESTION INSTRUCTIONSAND PROCEDURES WHEN ANSWERING YES If the answer to the basic qualification question (felonyquestion) is YES , submit as an exhibit a statement explainingthe circumstances and a statement giving the reasons why theApplicant believes that grant of the APPLICATION would be in thepublic interest notwithstanding the actual or allegedmisconduct.

6 If the Applicant responds YES to this questionand has previously provided a statement and explanationregarding the circumstances as an attachment to a priorapplication filed in ULS, and the facts and circumstances areunchanged, the Applicant may refer to the previous applicationby identifying the APPLICATION file number and indicating thedisposition of the prior APPLICATION . Find your FCC Applicationfile number: can send the explanation and the APPLICATION filenumbervia e-mail postal mailat: FCC, 1270 Fairfield Rd. Gettysburg, PA applicant is required to provide an explanationwithin 14days of the APPLICATION data being submitted to to do so may result in the APPLICATION dismissal withoutaction. The applicant must provide sufficient information for theFCC to determine whether there exists any material andsubstantial question of fact regarding whether the applicanthas the character qualifications to be a Commission is no set checklist of items, but useful information includes: a detailed description of the conduct that resulted in theconviction or guilty plea, including time and place the date of the conviction or guilty plea the punishment that was imposed, and whether thesentence has been completed, or the applicant is stillunder any restriction or condition resulting from theconviction or guilty plea any efforts taken to remedy the wrongs committed andensure that the applicant will not engage in such conductin the the applicant does not request confidential treatment, theexplanation will be publicly viewable in ULS.

7 If the applicantrequests that the explanation be confidential, it will not bevisible to the public. However, in order to seek confidentialtreatment, the applicant must include a separate request thatthe material not be made available for public inspection. Therequest must contain a statement of the reasons for therequest, and identify the portion(s) of the response for whichconfidential treatment is requested. It is not sufficient to simplymark a document as Confidential. All attachments,confidential or non-confidential should be accompanied by anapplication file number, to ensure that the explanation isattached to the proper FOR COMPLETING NCVEC form 605 APPLICATION