Ahrc Form 1046 2 E PDF Details

In the realm of military service and education, procedures and paperwork play a pivotal role in navigating the intersection between duty and learning. The AHRC Form 1046-2-E serves as a vital tool for service members seeking a renewal of their educational delay from entry on active duty, as well as for verifying enrollment in graduate or professional school. Grounded in the Privacy Act of 1974, the form requires detailed personal information, including Social Security Numbers and current mailing addresses, under the authority of Title 10, U.S. Code, to identify and maintain applicants' records. The primary purpose of this form is to assist service members in managing their transition between military service and advanced education, outlining expectations for both the applicants and the institution involved, Womack Army Medical Center (WAMC). It covers various aspects, from personal identification and delay information to conditions and medical certification, emphasizing the voluntary nature of disclosure while cautioning against the implications of non-compliance. In essence, AHRC 1046-2-E encapsulates a critical process for those at the juncture of military service and higher education, ensuring that applications for educational delays are handled with clarity, due diligence, and in accordance with legal guidelines.

QuestionAnswer
Form NameAhrc Form 1046 2 E
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesaspx, ahrc forms, TOEND, amrdec

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P R I V ACY ACT I N FO R M AT I O N : T h e a u t h o r it y f o r co lle ct io n o f in f o r m a t io n is T it le 1 0 , U . S. Co d e , se ct io n 1 5 5 2 , EO 9 3 9 7 . T h e p r in cip a l p u r p o se is f o r t h e

e n r o llm e n t o f st u d e n t s a t W o m a ck Ar m y M e d ica l Ce n t e r ( W AM C) . Ro u t in e U se : N o n e . D isclo su r e is v o lu n t a r y ; h o w e v e r , f a ilu r e t o p r o v id e id e n t if y in g in f o r m a t io n m a y im p e d e y o u r a b ilit y t o r e q u e st a n d e n r o ll a t W AM C.

APPLICATION FOR RENEWAL OF EDUCATIONAL DELAY FROM ENTRY ON ACTIVE DUTY AND VERIFICATION OF ENROLLMENT IN GRADUATE OR PROFESSIONAL SCHOOL

NOTIFICATION. UNDER THE PRIVACY ACT OF 1974

The Social Security Number (SSN) and current mailing adddress requested under Part 1 on this form are mandatory under Title 10, US Code, Section 275, 1001, and 4301. These items will be used for purpose of identification and maintenance. Failure to provide these items may result in the rmoval from delayed entry status, and subject the member to be called to active duty.

PART 1 - ADDRESS INFORMATION

1. NAME (LAST, FIRST, MI)

2. RANK

3. SOCIAL SECURITY NUMBER - LAST FOUR

 

 

 

4. STREET ADDRESS

5. CITY-STATE-ZIP CODE

6. TELEPHONE NUMBER (INCLUDE AREA CODE)

 

7. BRANCH (e.g. Inf, AG)

8. EMAIL ADDRESS

(H)

(W)

 

 

DL/MSC

 

 

 

 

 

 

 

 

 

 

 

PART II - DELAY INFORMATION

 

 

 

 

 

9: MAJOR FIELD OF GRADUATE STUDY

10. DEGREE OBJECTIVE

 

11. NAME AND ADDRESS OF INSTITUTION IN WHICH CURRENTLY

 

 

(CHECK

ONE)

 

ENROLLED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

❑ MA or MS

 

❑ PhD

 

 

 

 

 

❑ Other

 

 

 

 

 

 

 

 

 

 

 

 

 

12.-DATE DEGREE EXPECtED-TO BE AWARDED -13. DATE DELAY_ TO.COMMENCE

14. ,DATE DELAY TO,END (MONTH AND YEAR)

(MONTH AND Year)

(Month and Year)

Note: Renewal coannot exceed 1 year from Delay Commencement

 

JUNE

JUNE

 

 

 

PART III - DELAY NOT REQUESTED

15. I DO NOT INTEND TO APPLY FOR RENEWAL

SIGNATURE:

DATE:

PART IV - CONDITIONS & MEDICAL CERTIFICATE

16.I agree to the conditions below if my request for renewal of delay is approved:

a. The determination as to whether I will serve on active duty for training as set forth in the Supplemental Agreement attached hereto upon termination

of my delay status rests witht he Department of the Army.

-

b.I will be required to serve on active duty or active duty for training and in the Army Reserve as set forth in the Supplemental Agreement attached hereto.

c.I may be subject to transfer or reappointments to a different branch of service which would be more consistent with my post graduate subject discipline and military requirements.

d.My delay status may be terminated at any time by the Department of the Army because of overriding military requirements.

e.I will not be authorized delay for educational reasons when I obtain the degree indicated in item 10 of this from.

f.My active duty availability date will be the month following the month and year indicated in item 12, unless I am authorized further delay for other reasons, and I will be scheduled for active duty as soon as possible after my active duty availability date.

g.I realize that this is an annual renewal and cannot exceed one year from the date of commencement indicated in item 12 of this form.

17.CERTIFICATE OF PHYSICAL CONDITION. I CERTIFY TO THE BEST OF MY KNOWLEDGE AND BELIEF THAT I HAVE NO MEDICAL CONDITION OR PHYSICAL DEFECT WHICH WOULD PREVENT MY PERFORMANCE OF ACTIVE MILITARY SERVICE EXCEPT AS FOLLOWS:

YES / NO ❑

If your answer is YES please provide supporting documents or attach them.

SIGNATURE OF APPLICANT

DATE SIGNED

AHRC FORM 1046-2-E, JAN 2012PREVIOUS EDITIONS ARE OBSOLETE

W ARNING: Em a iling o f t his info rm a t io n is a t t he d iscre t io n o f t he a p p lica nt a nd use s t he a p p lica nt e m a il sy st e m . W o m a ck Arm y M e d ica l

Ce nt e r d o e s NOT a ssum e a ny lia b ilit y fo r t he int e rce p t io n o f t he info rm a t io n co nt a ine d o n t his fo rm . Use t he fo llo w ing sit e fo r e ncry p t ing a ny e m a ils se nt t o W AM C: ht t p s:/ / sa fe .a m rd e c.a rm y .m il/ SAFE/ W e lco m e .a sp x

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LFV 1.00

INSTRUCTIONS - Please Print of Type

PART I - ADDRESS INFORMATION - All items in Part I are to be completed. Please type or print legibly your name and complete address,

including zip code, since this will be used for mailing purposes.

PART II - DELAY INFORMATION -Items 9 thru 14 are to be completed by each officer requesting renewal of educational delay.

PART III - DELAY NOT REQUESTED - Item 15 is to be completed only if officer is not requesting renewal of educational delay.

PART IV - CONDITIONS & MEDICAL CERTIFICATE - Items 16 thru 17 should be carefully read and then signed by each officer requesting renewal of

educational delay. Any medical condition or physical defects indicated must be accompanied by 8 statemnt-from your doctor or to support your claim. Such statement must include diagnosis; date of illness or injury; prognosis;- expected date of recovery; and whether the disabilit is Considered temporary or permaned in nature.

RETURN COMPLETED FORM TO U.S. Army Human Resources Command, ATTN: AHRC-OPH-PAI Incentives Branch,

1600 Spearhead Division Ave Dept #270, Fort Knox, KY 40122

WARNING: Emailing of this information is at the discretion of the applicant and uses the applicant’s email system. Womack Army Medical Center does NOT assume any liability for the interception of the information contained on this form. Use the following site for encrypting any emails sent to WAMC: https://safe.amrdec.army.mil/SAFE/Welcome.aspx

IRC FORM 1046-2-E, JAN 2012

 

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How to Edit Ahrc Form 1046 2 E Online for Free

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It's simple to complete the form with this practical tutorial! Here is what you should do:

1. The WAMC needs certain details to be inserted. Ensure that the subsequent fields are completed:

1974 completion process shown (part 1)

2. Your next stage is to submit the next few blanks: I DO NOT INTEND TO APPLY FOR, DATE, SIGNATURE, PART IV CONDITIONS MEDICAL, I agree to the conditions below, a The determination as to whether, of my delay status rests witht he, b I will be required to serve on, hereto, c I may be subject to transfer or, discipline and military, d My delay status may be, e I will not be authorized delay, f My active duty availability date, and reasons and I will be scheduled.

1974 writing process detailed (stage 2)

People who use this PDF often make some errors when completing a The determination as to whether in this part. You need to re-examine what you type in here.

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