Form 295 – Fill Out and Use This PDF

APPLICATION FOR THE EVALUATION OF

LEARNING EXPERIENCES DURING MILITARY SERVICE

	(Date) (YYYYMMDD)
TO: (Name and address of educational institution,	EVALUATION REQUEST FOR:
agency, or employer)
	(Name of Applicant)
	(Social Security Number)

ATTENTION:

Dear Of f icial:

The applicant named above has request ed t hat t he at t ached summary of educat ional achievement s, accomplished w hile in t he Armed Forces of t he Unit ed St at es, be f orw arded t o you f or review and evaluat ion.

The American Council on Educat ion publishes t he Guide to the Evaluation of Educational Experiences in the Armed Services The Guide series cont ains post secondary credit recommendat ions f or select ed milit ary courses and occupat ions. The 1954-1989 Guide cont ains recommendat ions spanning t he dat es 1/1954 - 12/1989, and should be kept as a permanent resource. The current edit ion cont ains credit recommendat ions f rom 1/1990 t o t he present , and is published every t w o years. In addit ion, supplement al handbooks are issued at 6-mont h int ervals bet w een Guide publicat ions. The handbook cont ains recommendat ions f or all evaluat ions conduct ed af t er t he publicat ion of t he current Guide.

This f orm cont ains a record of a Service member' s milit ary courses and occupat ions. It should be signed by a milit ary of f icial w hose signat ure cert if ies t hat t he inf ormat ion t hat is ent ered on t he f orm is accurat e and is t aken direct ly f rom original records. ACE ID numbers are ent ered in column 18 by milit ary educat ion of f icers.

The American Council on Educat ion maint ains an advisory service t o provide credit recommendat ions f or courses, t est s, and occupat ions t hat cannot be locat ed in any of t he Guide publicat ions. If ACE ID numbers have been ent ered int o column 18, it is not necessary t o submit t his f orm t o ACE. If t here are quest ions about any of t he ent ries, t he inst it ut ional of f icial may cont act ACE f or addit ional inf ormat ion. Credit recommendat ions are not provided t o inst it ut ions at t he applicant ' s request .

Aut horized persons may submit quest ions t o ACE at t he f ollow ing address: American Council on Educat ion, Cent er f or Adult Learning and Educat ional Credent ials, One Dupont Circle, Washingt on,

DC 20036-1193, ATTN: Milit ary Evaluat ions. Telephone: (202) 939-9470; Fax: (202)

775-8578; e-mail: mileval@ace.nche.edu.

The evaluat ion of t his applicant ' s learning experiences, as w ell as any guidance you may provide, should be sent direct ly t o t he applicant at t he address show n in Block 6 on page 3.

Sincerely,

PRIVACY ACT STATEMENT

AUTHORITY: 10 U.S.C. 2007; P.L. 104-106; and E.O. 9397.

PRINCIPAL PURPOSE(S): To f acilit at e an individual' s request f or evaluat ion of educat ional experiences w hile in t he milit ary services.

ROUTINE USE(S): None.

DISCLOSURE: Volunt ary; how ever, you w ill not be evaluat ed f or your educat ional experiences during milit ary service if you f ail t o provide request ed inf ormat ion.

INSTRUCTIONS TO APPLICANT

INSTRUCTIONS TO CERTIFYING OFFICER

(Custodian of Personnel Records)

INSTRUCTIONS TO EDUCATION OFFICER

DD FORM 295, APR 2000

Page 2 of 4 Pages

APPLICATION FOR THE EVALUATION OF LEARNING EXPERIENCES

DURING MILITARY SERVICE

TO (Name and address of educational institution, agency, or employer)

SECTION I - TO BE COMPLETED BY APPLICANT

5. PRESENT BRANCH OF SERVICE (Includes National Guard and Reserve components)

	ARMY		NAVY		AIR FORCE		MARINE CORPS		COAST GUARD

6. APPLICANT' S MAILING ADDRESS FOR REPLY FROM EDUCATIONAL INSTITUTION

CIVILIAN EDUCATION

9	. HIGHEST GRADE OF SCHOOL COMPLETED (X one)
				7		8		9			10		11		12
		6
10	. HIGHEST YEAR OF COLLEGE COMPLETED (X one)											11. COLLEGE DEGREE EARNED (X if applicable)
		NONE		FRESHMAN		SOPHOMORE		JUNIOR			SENIOR		ASSOCIATE		BACHELOR
				(1 - 29 S.H.)		(33 - 59 S.H.)		(60 - 89	S.H.)		(90 - 100 S.H.)
12	. EDUCATIONAL INSTITUTION LAST ATTENDED

13. MILITARY CORRESPONDENCE COURSES COMPLETED (The applicant should attach a copy of the course completion letter or certificate.)

	a. COURSE NAME	b. ACE GUIDE COURSE OR	c.	COURSE SPONSOR	d. DATE COURSE
					COMPLETED
	(If no courses w ere taken, print NONE)	OCCUPATION IDENTIFICATION NUMBER	(AIPD, MCI, ECI, CGI)
					(YYYYMMDD)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

(18)

(19)

(20)

14. APPLICANT CERTIFICATION: I have read the Privacy Act Statement on Page 2.

DD FORM 295, APR 2000

Page 3 of 4 Pages

SECTION II - TO BE COMPLETED BY CERTIFYING OFFICER

(Read Instructions on Page 2 before completing this page)

15. FORMAL SERVICE SCHOOLS ATTENDED (If 40 hours in 5 consecutive days, or if longer than 32 hours in 5 consecutive days.) (If none, print NONE.)								18. ACE GUIDE COURSE
								OR OCCUPATION
				d. DATE	e. LENGTH	f. DATE	g. FINAL MARK
								IDENTIFICATION NO.
a. COURSE TITLE	b. MILITARY COURSE		c. NAME OF SCHOOL,				AND/OR CLASS
				ENTERED	(In w eeks)	COMPLETED
(Do Not Abbreviate)	NUMBER		CITY, STATE				STANDING	(To be filled out in
				(YYYYMMDD)	(Note 1)	(YYYYMMDD)
							(Note 2)	Education Center)
(1)
(2)
(3)
(4)
(5)
(6)
16. MILITARY OCCUPATIONAL HISTORY
a. MILITARY SPEC. CODE				c. DATES HELD		d. MOS/SQT/SDT SCORE
	b. MILITARY OCCUPATIONAL TITLE
(MOS, AFSC, Rate, etc.)				(1) FROM	(2) TO	(For Army Enlisted Personnel)
		(Do Not Abbreviate)
(Note 3)				(YYYYMMDD)	(YYYYMMDD)	(Note 4)
(1)
(2)
(3)

NOTES: 1.	Print SP if course lengt h w as self paced.	3.	List most recent skill levels or grade.
2.	If inf ormat ion is available, give grade received. If class st anding is show n, give number in class, e.g., 10 in 241.	4.	MOS/SQT/SDT Evaluat ion Score and dat e of evaluat ion.

THIS APPLICATION MUST BE SIGNED BY AN OFFICER OR A DULY AUTHORIZED NONCOMMISSIONED OFFICER.

I cert if y t hat t he inf ormat ion cont ained herein has been compared w it h of f icial records, and t hat t his inf ormat ion is correct .

DD FORM 295, APR 2000

Page 4 of 4 Pages