Form 131 R – Fill Out and Use This PDF

CADET ACTION REQUEST

(ROTC Cadet Command Pam 145-4)

Data required by the Privacy Act of 1974

Authority: 10 USC 2102 and 2107. Principal Use(s): For use by cadet or battalion commander/PMS in initiating a request for personnel action.

Routine Use(s): To initiate cadet actions for waivers, exception, or change in scholarship status by the Cadet or battalion commander/PMS.

Disclosure: Voluntary. However, failure to provide necessary action will preclude consideration of the request.

SECTION I - PERSONAL DATA

8. SMP UNIT ADDRESS (If applicable):

SECTION II – REQUEST FOR PERSONNEL ACTION

9. I request the following action: (Check the appropriate)

SECTION III – (Applies to Section II for all actions excluding Waiver of Rights)

10. Reason for the Request/Remarks: (Continue on blank sheet)

SECTION III – (CONTINUATION)

13. BATTALION COMMANDER/PMS CERTIFICATION AND RECOMMENDATION:

I certify that the cadet enrollment and retention information submitted with this request is accurate and complete. This action request has been reviewed and is complete in accordance with Cadet Command PAM 145-4.

I recommend the following action be taken: (Check Appropriate)

Remarks:

SECTION IV – REMARKS (Applies to Section II) (WAIVER OF RIGHTS ONLY)

16. Under the provisions of Army Regulation 145-1, paragraph 3-43a( ), disenrollment from the ROTC program is initiated due to the cadet’s breach of the Army Senior Reserve Officers’ Training Corps (ROTC) Scholarship Cadet Contract, DA 597-3, based on (insert reason, i.e. academic GPA failure).

I certify that the waiver of rights documentation has been completed IAW CC PAM 145-4. Copies of the documentation and/or supporting documents as indicated above have been provided to the cadet and the cadet has been afforded an opportunity to comment. The documentation will be maintained in the cadet’s Military Personnel Records Jacket and becomes a part of the official personnel records as confirmation of disenrollment, obligation, and agreements.