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AETV-_______________  (635-200)                                                             DATE:

 

 

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

 

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