ADAMS, JOHN CPT 000-00-0000

Human Capital Management Division

National Guard Bureau

111 S. George Mason Drive

Arlington, VA 22204

YOUR OPR CPT JOHN ADAMS

(ORGANIZATION)INFORMATION

Congressional Fellowship Program

"I UNDERSTAND IF AWARDED THIS FELLOWSHIP, I WILL INCUR TWO SEPARATE ACTIVE DUTY SERVICE OBLIGATIONS

(ADSOS) IN THE UNITED STATES ARMY. ADSOS WILL BE THREE TIMES THE LENGTH OF THE PERIOD, COMPUTED IN DAYS,

WHICH I AM EDUCATED UNDER THE PROVISIONS OF THIS PROGRAM. ONE ADSO WILL BE FROM PURSUING A GRADUATE

DEGREE FROM GEORGE WASHINGTON UNIVERSITY AND THE SECOND ADSO WILL BE FROM PARTICIPATING IN THE ARMY

CONGRESSIONAL FELLOWHSIP PROGRAM. BOTH ADSOS WILL BE SERVED CONCURRENTLY, APPROXIMATELY A FOUR YEAR

ADSO. I UNDERSTAND THE GRADUATE DEGREE ADSO WILL NOT BEGIN UNTIL THE DAY AFTER I GRADUATE FROM GEORGE

WASHINGTON UNIVERSITY AND MY SECOND ADSO WILL NOT BEGIN UNTIL THE DAY AFTER I COMPLETE THIS PROGRAM. I

ALSO UNDERSTAND I AM OBLIGATED TO SERVE A TWO YEAR MANDATORY UTILIZATION ASSIGNMENT IMMEDIATELY

FOLLOWING AND UTILIZATION ASSIGNMENT UNINTERRUPTED AND WITHOUT ANY DEFERMENT FOR ANY REASON. I

UNDERSTAND THE ADSOS I RECEIVE UNDER THIS PROGRAM ARE TO BE SERVED CONSECUTIVELY WITH OTHER CIVILIAN

ADSOS. I AUTHORIZE RELEASE OF COPIES OF MY APPLICATION TO OTHERS WHO MAY REQUIRE THEM IN CONNECTION

WITH MY NOMINATION AS AN ARMY CONGRESSIONAL FELLOW."

PERSONNEL ACTION

(Section III).

Used by soldier in accordance with DA PAM 600-8-21 when requesting a personnel action on his/her own behalf

Identification Card

Identification Tags

Separate Rations

Leave - Excess/Advance/Outside CONUS

Change of Name/SSN/DOB

DATA REQUIRED BY THE PRIVACY ACT OF 1974

SECTION I - PERSONAL IDENTIFICATION

SECTION V - CERTIFICATION/APPROVAL/DISAPPROVAL

7. The above soldier's duty status is changed from to

effective hours,

SECTION III - REQUEST FOR PERSONNEL ACTION

RECOMMEND APPROVAL IS DISAPPROVED RECOMMEND DISAPPROVAL IS APPROVED

DA FORM 4187, JAN 2000 PREVIOUS EDITIONS ARE OBSOLETE

HAS BEEN VERIFIED

APD PE v1.00ES

AUTHORITY:

PRINCIPAL PURPOSE:

DISCLOSURE:

Title 5, Section 3012; Title 10, USC, E.O. 9397.

ROUTINE USES: To initiate the processing of a personnel action being requested by the soldier. 

5. GRADE OR RANK/PMOS/AOC 6. SOCIAL SECURITY NUMBER

Special Forces Training/Assignment

Retesting in Army Personnel Tests

Reassignment Married Army Couples

Reclassification

Officer Candidate School

Asgmt of Pers with Exceptional Family Members

ROTC or Reserve Component Duty

Volunteering For Oversea Service

Ranger Training

Reassignment Extreme Family Problems

Airborne Training

12. COMMANDER/AUTHORIZED REPRESENTATIVE 13. SIGNATURE

Circle the appropriate copy designator

Copy 1 Copy 2 Copy 3 Copy 4

For use of this form, see AR 600-8-6 and DA PAM 600-8-21; the proponent agency is ODCSPER

11. I certify that the duty status change (Section II) or that the request for personnel action (Section III) contained herein - 

 SECTION II - DUTY STATUS CHANGE (AR 600-8-6)

 SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)

8. I request the following action: (Check as appropriate)

4. NAME (Last, First, MI)

1. THRU (Include ZIP Code) 2. TO (Include ZIP Code) 3. FROM (Include ZIP Code)

On-the-Job Training (Enl only)

Service School (Enl only)

Exchange Reassignment (Enl only) Other (Specify)

9. SIGNATURE OF SOLDIER (When required) 10. DATE (YYYYMMDD)

14. DATE (YYYYMMDD)

Voluntary. Failure to provide social security number may result in a delay or error in processing of the request for

personnel action.