Request for New Coordination or
Update an Existing Coordination

Submit this form to request coordination of a new repeater, request a change of repeater frequency pair, or update an existing coordination with changes that affect the repeaters coverage area (location, antenna height or effective radiated output power).

Fields marked with an asterisk are REQUIRED.  Entry of an invalid email address will cause your application to be discarded and 
not processed (e-mail addresses are kept confidential).  Applications that are submitted with erroneous, conflicting or missing 
information will be returned to the applicant unprocessed.  The applicant may re-submit the application but the original date of 
submission will not be honored.
REPEATER TRUSTEE
By entering my name and date in the boxes below, I CERTIFY that the information provided is complete and accurate.

*Licensee's full name:       *Licensee's Call Sign: 
(Supply the name and callsign of the TRUSTEE not the SPONSOR (or club)


*E-mail address:              *Date submitted (MM-DD-YY): 

*Address:                 
*City:                         *State:      *Zip: 
*Home phone:              ()   Work phone: ()

HOLDER OF THE COORDINATION
(This is the individual or group that controls the coordination and has the authority to change the trustee or "Holder" information, 
transfer or relinquish the coordination, or change its technical parameters.  See our Coordination Policy, 
section 7 for more information).
 
*Holder of the coordination:    
*Address:                  
*City:                         *State:      *Zip: 
*Phone:                    ()
REPEATER SPONSOR (leave blank if same as trustee)
(This is the club or other organization that uses and/or supports the repeater but has NO AUTHORITY to make changes to the 
coordination.  See our Coordination Policy, section 7 for more information).
 
Name of sponsor or club:       Callsign: 
Address:                  
City:                         State:      Zip: 
Phone:                    ()
REPEATER PARAMETERS
*Repeater callsign: 
*Input frequency:    (MHz) (the user TRANSMITS on this frequency to the repeater)
*Output frequency:   (MHz) (the repeater TRANSMITS on this frequency to the user)
*Band: 
*Repeater city:         *County:       *District:    (click HERE for a map and county list)
*Latitude:          deg  min  sec North       Longitude:   min sec West

 NOTE: LATITUDE AND LONGITUDE PARAMETERS ARE DEGREES-MINUTES-SECONDS.  BY DEFINITION, MINUTES AND SECONDS CANNOT BE MORE THAN 59!
 NOTE: QRZ.COM'S DEFAULT COORDINATES ARE FOR THE CENTER OF YOUR ZIP CODE.

(Click HERE to access the FCC's coordinate converter).
(Click HERE to access Stephen Morse's coordinate search and conversion page).

*Repeater street address or the tower's ASRN:   (for coordinate verification)
*Transmitter output (PEP):            Watts
NOTE: 440 TRANSMITTERS MUST NOT EXCEED 50 WATTS WITHOUT WRITTEN PERMISSION FROM THE MILITARY FREQUENCY COORDINATOR.

*Repeater output (ERP):               Watts   (click HERE for worksheet)

*Is the repeater in service now?        If No, when (MM-DD-YY)?                 

*Antenna height (feet above ground):     *Site elevation (feet above sea level): 
*Antenna omnidirectional:               If No, direction of max gain (degrees):  

REPEATER OPERATING FEATURES

*Repeater access:                  
*Repeater format 1:                
*Repeater format 2:                 (if different than format 1)
APCO 25 NAC:                        (click HERE for the recommended network access code (NAC) by region)
CTCSS access:                      
CTCSS frequency:                    (Hz) (click HERE for the recommended frequency by region)
DCS access:                        
DCS code:                          
IRLP access:                       
IRLP node number:                  
EchoLink access:                   
EchoLink node number:              
TRBO color code:                   
TRBO group code:                   
NXDN RAN code:                     
Bilingual:                         
Remote base:                       
Autopatch equipped:                
Autopatch availability:            
Linked/cross band:                 
Emergency power:                   
Emergency power from the wind:     
Emergency power from the sun:      
Direct access to law enforcement:  
ARES:                              
RACES:                             
Wide area coverage:                
Weather:                           
LiTZ:                              

Is your 2-meter repeater synthesized or crystal-controlled?   (leave blank if not 2-meter)
Does your 2-meter repeater support narrowband (2.5 kHz deviation)?    (leave blank if not 2-meter)

What is the frequency of your D-STAR repeater's data channel?   (leave blank if not D-STAR or there is no data channel)
Does your D-STAR repeater have a gateway to the internet?   (leave blank if not D-STAR)
Does your D-STAR gateway require financial compensation for use?   (leave blank if not D-STAR)
Does your D-STAR gateway use the US-Trust server?   (leave blank if not D-STAR)
Does your D-STAR gateway use the IrcDDB server?   (leave blank if not D-STAR)


List the OUTPUT frequencies of other repeaters in the local area that your system links to (full or part time), 
separated by commas:


The following optional information is now being requested by the ARRL for their Repeater Directory.  If provided,
these codes will be reported and may be published.

Repeater DTMF access code:          (for repeaters that require DTMF for access)
Autopatch DTMF access code:        
Law Enforcement DTMF access code:  
Weather DTMF access code:          

Please indicate the Location of the repeater by supplying the following:

The 4 streets enclosing the repeater:

  
  

The nearest major roadways:

  

Please indicate the section of the city where the repeater is located:  

Remarks:
LINK AND CONTROL FREQUENCIES

Please indicate below any link or control frequencies in use by your system (not simplex and repeater frequencies you link to).
This information is held confidential.  After 09/11/2004, new coordinations may be issued on any frequency pairs between
440 to 441.975 MHz output (445 to 446.975 MHz input) unless reported to be in-use for links or control.


   

      
         
Frequency(s)
      

      
         
Use

      		
      
         
Antenna Polarization

      		
      
         
Antenna Direction (compass heading)

      		
      
         
Currenty in use? (yes or no)