For use of this form, see PAM 600-8; the proponent agency is DCS, G-1.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Title 10, USC, Section 3013, E.O. 9397 (SSN), as amended
To request or record personnel actions for or by Soldiers in accordance with DA PAM 600-8.
The DoD Blanket Routine Uses that appear at the beginning of the Army's compilation of systems of records may
apply to this system.
Voluntary; however failure to provide Social Security Number may result in a delay or error in processing the
request for personnel action.
3. FROM (Include ZIP Code)
1. THRU (Include ZIP Code)
2. TO (Include ZIP Code)
Directorate of Human Resources
U.S. Army Student Detachment
5450 Strom Thurmond Blvd
5450 Strom Thurmond Blvd
Fort Jackson, SC 299207
Fort Jackson, SC 29207
SECTION I - PERSONAL IDENTIFICATION
4. NAME (Last, First, MI)
5. GRADE OR RANK/PMOS/AOC
6. SOCIAL SECURITY NUMBER
Doe, John A
SECTION II - DUTY STATUS CHANGE (AR 600-8-6)
7. The above Soldier's duty status is changed from
SECTION III - REQUEST FOR PERSONNEL ACTION
8. I request the following action: (Check as appropriate)
Special Forces Training/Assignment
ROTC or Reserve Component Duty
Volunteering For Oversea Service
Retesting in Army Personnel Tests
Reassignment Married Army Couples
Leave - Excess/Advance/Outside CONUS
Reassignment Extreme Family Problems
Change of Name/SSN/DOB
Officer Candidate School
OCONUS FLPB EXTENSION
Asgmt of Pers with Exceptional Family Members
9. SIGNATURE OF SOLDIER (When required)
10. DATE (YYYYMMDD)
SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)
1. Soldier currently receives Foreign Language Proficiency Bonus (FLPB) for Spanish, IAW AR 11-6
2. Soldier is due for an annual certification, but is currently assigned OCONUS at (U.S. Embassy, Santiago, Chile) where a testing
center is unavailable.
3. Soldier understands that there is a two year consecutive limit on this exemption and must re-certified using the DLPT or OPI as
soon as practical or within 180 days of the order’s date releasing them from the duty assignment.
4. Soldier can be reached at (official enterprise and program email address).
5. I (Program Supervisor Name) certify that the recipient can perform his/her linguistic duties in a satisfactory manner and is
proficient at a level consistent with their current proficiency scores.
Current DA Form 330(s)
SECTION V - CERTIFICATION/APPROVAL/DISAPPROVAL
11. I certify that the duty status change (Section II) or that the request for personnel action (Section III) contained herein -
HAS BEEN VERIFIED
12. COMMANDER/AUTHORIZED REPRESENTATIVE
14. DATE (YYYYMMDD)
E. VICTORIA NIETO, CPT, AG, CDR
SUPERSEDES DA FORM 4187, JAN 2000
DA FORM 4187, MAY 2014
Page 1 of 2
AND REPLACES DA FORM 4187-1-R, APR 1995
APD LC v1.03ES