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APPLICATION FOR ASSIGNMENT TO HOUSING 1. TYPE …

APPLICATION FOR ASSIGNMENT TO HOUSING (Before completing form, read Privacy Act Statement and Instructions on reverse) SERVICE DESIRED (X one or both)a. MILITARY REFERRALSECTION I - APPLICANT INFORMATION OF SPONSOR (Last, First, Middle Initial) (Street, City, State, Zip Code) OF APPLICANT (X one)a. HOME (Area Code) (DSN) NATIONAL STATUS 10. I AM SEPARATED FROM MY DEPENDENTS (X one) REQUEST HOUSING FOR (X one)SECTION II - MILITARY CAREER INFORMATION (Civilians skip to Item 15.) AND DEPENDENTS (Enter in YYMMDD order)MILITARY APPLICANT MILITARY SPOUSE TRANSFERRED RANK/RATE DATEb.

Whether the sex offender is the military member, civilian or dependent Nature and circumstances of the offense Exact criminal statute or law under which the person was convicted

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