Da Form 145 – Fill Out and Use This PDF

Army Correspondence Course Enrollment Application

DATE (YYYYMMDD)

For use of this form, see DA PAM350-59;The proponent agency is TRADOC.

DATA REQUIRED BY THE PRIVACY ACT

AUTHORITY:

10USC3012(B) and (G).

PRINCIPALPURPOSE:

To obtain information necessaryby Army schools to administer student participation in the Army Correspondence Course Program.

ROUTINEUSES:

Used by Army schools to obtain basic data needed to determine eligibility for enrollment, process applications, maintain student records,

and perform all other administrative functions inherent in student administration.

DISCLOSURE:

Mandatory. Failure to provide this information could result in the applicant not being able to participatein the program.

1. Student SSN

2. Primary MOS/Duty MOS

3. CIV-SERIES

4. AOC Duty Position

5.

ASI/SQI 6. Branch 7. DSN (Telephone)

COMM (Telephone)

8. Group Number

10. Component 11. RYE Date Month

13. Enrollment

9.

Rank/CivGrade

Code

Day

(Abbreviate)

Year

12.School Grade

Code 14. Phase

15.

Course Number

16.Rep Qty

17.

Unit Identification Code

18. Subcourse Exemption

NOTE:

If

you

were

previously

enrolled

in

this

course,

indicate

date

of

termination

of

enrollment.

Are you currently enrolled in the ACCP? Yes No

Unit Address Line 1

Unit Designation (May not be left blank)

Unit Address Line 2

P.O. Box or Street (May not be left blank)

Unit Address Line 3

City, Post or APO/FPO

STATE or AE/AP/AA

ZIP + 4

FROM: (Mailing address to which subcourses are to be sent).

22. Last Name

First Name

Middle Initial

Student Address Line 3 City, Post or APO/FP

STATE or AE/AP/AA ZIP + 4

DA FORM 145, OCT 2000

REPLACES EDITION OF JAN 1992, WHICH IS OBSOLETE

USAPA V1.00

24.

I

have reviewed DA PAM 350-59, and understand the

eligibility requirements that

I must maintain

to sustain my enrollment in this

course.

I further understand that assistance is not authorized when completing subcourse test.

Signature of Applicant

25.

I

have reviewed the course objectives and prerequisite

enrollment requirements in

DA PAM 350-59

and determined the applicant is

eligible

for enrollment in this course.

Unit Cdr or other approving officer.

Name (printed or typed

Date (YYYYMMDD)

1. Student SSN

9. Rank/Civ Grade

244320164

SGTMAJ

ITEM 1.

SSN: F

oreign students must leave blank.

ITEM 2.

Studeni t’s PMOS (Primary MOS) and DMOS (Duty MOS). Enter numeric and alpha identifiers.

ITEM 3.

Civ-Ser

es number (for example 1702).

ITEM 4.

AOC A

rea of Concentration or Duty Position. Submit information required to qualify for enrollment.

ITEM 9.

RANK:

RA warrant officers and enlisted personnel who hold a reserve

commission and

are

enrolling in officer career c evelopment

courses

must enroll in their reserve capacity.

ITEM 10.

Compo nent Code: Student categories: Enter one of the following as appropriate:

02

Act ve Duty Officer

09 USAR ENL

15 FGN CIV

20 CADET

03

RA/AUS ENL

10 NGUS ENL

16 USAF

31 IRR (OFF)

06

RET MILITARY

12 NDCC/ROTC/JR

17 USN

32 IRR (ENL)

07

USZXR OFF/WO

13 FGN MIL

18 USCG

33 NAF (VOL)

08 NGl

JS OFF/WO

14 U.S. CIV

19 USMC

ITEM 11. RYE Date (Retirement Year Ending Date): USAR and NG applicants

not

on active

duty

must

enter the anniversary date of their

retiremiant year ending day and month.

Where

to mail application:

SCHOOL MAI

_ING ADDRESS: Please check DA PAM 350-59 for appropriate

address

of

school

with whom you are seekirlg enrollment,

e.g Academy

of Health Science, The Judge

Advocate General's School,

Army

Logistics

Management College, or the Arrm/ Institute for

REVERSE OF DA FORM 145, OCT 2000

USAPA V1.00