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REQUEST FOR CONDITIONAL RELEASE

REQUEST FOR CONDITIONAL RELEASE (Read Privacy Act Statement and Instructions on back before completing this form.)SECTION I - REQUEST FOR RELEASE1. SERVICE MEMBER DATA2. RECRUITING OFFICE ADDRESSa. NAME (Last, First, Middle Initial)b. PAY GRADEd. SERVICE COMPONENTc. SSN or EDIPI3. ACKNOWLEDGEMENT OF SERVICE MEMBERa. I REQUEST a CONDITIONAL RELEASE to process for entrance into another component of the Military Service. If I am a member of the National Guard orReserve, I understand that I must attend all scheduled training until such time as I am enlisted or appointed into another Service.

DISCLOSURE: Voluntary; however, failure to furnish all requested information may result in delay or denial of release from current Military Service. INSTRUCTIONS GENERAL INSTRUCTIONS. When this form is not computer generated, use typewriter or dark ink for all entries. Enter all dates in YYMMDD format.

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