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Annex A: AFAP Forum Application to 2ID OPORD 11 449 (AFAP Conference FY12) DATA REQUIRED BY THE PRIVACY ACT 1974: AUTHORITY: 5 USC 301, 10 USC 3013. PRINCIPAL PURPOSE: Identification of participants in the Army Family Action Plan Conference ROUTINE USES: Used to record the names and attendees at the Army Family Action Plan Conference for networking purposes. DISCLOSURE: Disclosures is voluntary. If the requested information is not provided, registration for the conference and the inclusion in the conference may not be possible. NAME: ______________________________________________________________ Last

First

Middle

MAILING ADDRESS:____________________________________ APO, AP ________ LAST 4 SSN: __________ E-MAIL (required): _______________________________ TELEPHONE: WORK: ___________ HOME: ______________FAX: ______________ COMPLETE ALL THAT MAY APPLY 1. Your military affiliation? a. Are you a: Soldier or Retiree Spouse of a Soldier or Retiree BOSS Soldier b. Are you or your sponsor? Active-Duty Reserve Civilian c. Rank: ______________ d. MOS/Branch_________________ 2. Are you: a. DA Civilian Employee Spouse of a DA Civilian APF (GM, GS, WG) NAF (NF) b. Grade/Series __________________ c. Job Title: _____________________ d. DEROS: _____________________

4. Your family type? Dual-Military Civilian

Sole Parent Other

5. Have you participated in a Family forum before? YES NO Installation, what year(s)? ___________ MACOM, what year(s)? _____________ DA, what year(s)? _________________ Never participated__________________ 6. What is your status in Korea? Command Sponsored Non-command Sponsored

Unaccompanied Single

7. Work Group Preference: st nd rd Please rank 1 , 2 , 3 _____Force Support & Entitlements _____Medical & Dental _____Relocation & Transportation _____Family & Community Services

3. Your marital status? Single Married Widower/Widow Delegate’s Signature ______________________ Commander's Signature________________________ Please return this application to su.mcclintock@korea.army.mil or DSN FAX: 732-6876 by 07 1300 OCTOBER 2011. If you have questions please call the USAG Red Cloud AFAP Coordinator DSN 730-4805 or 730-3107.

AFAP Delegate  

AFAP Delegat app

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