NAME: ________________________________________ Date: ___________________

RANK: ________________

DOB: _________________

TAFMS Date: ____________________

UNIT OF ASSIGNMENT: ____________________

AFSC:___________________________

DUTY PHONE: ______________________ HOME PHONE: ____________________

ADDRESS: _______________________________________

________________________________________________

________________________________________________

DUTY TITLE: ____________________________________________

DUTY DESCRIPTION: __________________________________________________

____________________________________________________________________

____________________________________________________________________

COLLEGE ENROLLED IN: _____________________________

MAJOR: _____________________________________________

CLASS/CLASSES ENROLLING FOR THIS QUARTER: _______________________

_________________________________________________________________

_________________________________________________________________

CAREER GOALS: ______________________________________________________

____________________________________________________________________

EMAIL ADDRESS: _________________________________

SIGNATURE___________________________________________