Da Form 5434 - Sponsorship Program Counseling And Information Sheet
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SPONSORSHIP PROGRAM COUNSELING AND INFORMATION SHEET
For use of this form, see AR 600-8-8; the proponent agency is ACSIM.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
Title 5, USC Section 301.
Personnel service support. To counsel Soldier or civilian employee about sponsorship program entitlements, and provide information to gaining
PRINCIPAL PURPOSE:
battalion or activity of new members.
ROUTINE USES:
None. The DoD Blanket Routine Uses set forth at the beginning of the DoD's compilation of systems of records notices may apply to this system.
Mandatory for service members. Nondisclosure may prevent participation in the sponsorship program.
DISCLOSURE:
1.
NOTE: Soldiers/Family members/Civilians may retrieve information regarding their new assignment at Army Knowledge Online -
https://
I have been counseled on the
I would like to have a sponsor assigned to me. (Complete remainder of form.)
FOR CIVILIAN EMPLOYEES ONLY:
Total Army Sponsorship Program
I decline the offer of sponsorship. (Complete Section 1 only.)
Typed or Printed Name:
Rank/Grade:
MOS/Branch/Civilian Occupational Series:
Signature:
Date:
2.
ARRIVAL INFORMATION TO ASSIST GAINING UNIT OR ACTIVITY: If additional space is necessary, please attach your documentation to the form)
a.
I
(Rank/Grade and Name):
, am on assignment to (Gaining Installation):
and expect to arrive on/about (Month and Year):
b.
Soldier's/Civilian's contact information:
Current Unit/Activity Address:
DSN Phone number:
Cell Phone number:
Email address:
Other (i.e., Social Media):
Leave Address and Phone number at this address until:
c.
Status
(check one):
Married-accompanied
Single-accompanied
Married-unaccompanied
Single-unaccompanied
Exceptional Family
d.
Accompanied by Family members:
NAME
AGE
SEX
RELATIONSHIP
Member Program (EFMP)
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
3.
GAINING UNIT/ACTIVITY INFORMATION: If additional space is necessary, please attach your documentation to the form)
a.
d.
Gaining Unit/Activity:
Unit 1SG/Supervisor:
b.
Unit CDR/Supervisor:
Phone number:
Phone number:
Email address:
e.
Email address:
TASP Unit Coordinator:
c.
Unit sponsor:
Phone number:
Phone number:
Email address:
f.
Email address:
Date of initial contact:
LOSING UNIT/ACTIVITY INFORMATION: If additional space is necessary, please attach your documentation to the form)
4.
a.
c.
Losing Unit/Activity:
Unit 1SG/Supervisor:
b.
Unit CDR/Supervisor:
Phone number:
Phone number:
Email address:
d.
Email address:
TASP Unit Coordinator:
Phone number:
Email address:
5.
FAMILY CONSIDERATIONS: If additional space is necessary, please attach your documentation to the form)
a.
b.
c.
Housing requirements (check one):
Pets:
Child care requirements:
Yes
No
Yes
No
Off-post housing
If yes, list pet and type:
On-post housing
d.
Spousal Employment info:
Yes
No
e.
List of local schools:
Yes
No
If yes, list type of work:
f.
g.
Contact by Unit Family Readiness Group (FRG):
Additional comments:
If yes, list Email address:
Yes
No
PREVIOUS EDITIONS ARE OBSOLETE.
APD LC v1.02ES
DA FORM 5434, DEC 2012
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