MEMORANDUM
FOR Criminal Law, ATTN: NCOIC, Military
Justice Section, APO AE 09034
SUBJECT: Request for Administrative Separation
1. Soldier’s Personal Data:
|
|
|
|
|
|
|
|
|
|
|
|
NAME |
|
RANK |
|
SSN |
|
SEX |
|
RACE |
|
|
|
|
||||||||
UNIT
|
|
||||||||
2. Recommend Separation Under:
Chapter 5-8 –
Involuntary Separation Due to Parenthood
Chapter 5-13 –
Personality Disorder
Chapter 5-17 –
Other Designated Physical or Mental Conditions
Chapter 7 –
Fraudulent Enlistment
Chapter 9 –
Alcohol/Drug Rehabilitation Failure
Chapter 11 –
Entry Level Status Performance and Conduct
Chapter 13 –
Unsatisfactory Performance
Chapter 14-5 –
Conviction by Civil Court
Chapter 14-12a -
Minor Disciplinary Infractions
Chapter 14-12b –
Pattern of Misconduct
Chapter 14-12c –
Commission of a Serious Offense
Chapter 15 –
Discharge for Homosexual Conduct
Chapter 18 –
Failure to Meet Body Fat Standards
3. Recommend the soldier’s term of service be
characterized as:
|
|
Honorable |
|
General,
under honorable conditions |
|
Under
other than Honorable conditions |
4. Is this soldier pending a medical evaluation
board (MEB)?
|
|
Yes |
|
No |
5.
POC
for this action is (include phone number): ____________________
___________________________
___________________________
___________________________
Commander’s
Signature Block