Wtc Form 100 - Army National Guard Warrior Training Center Enrollment Form
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1ARMY NATIONAL GUARD WARRIOR TRAINING CENTER
ENROLLMENT FORM
NAME (Last, First, MI)
RANK
LAST 4 OF SSN
MOS / BRANCH
UNIT (CO, BN, BCT, and Address)
UIC
Soldier successfully completed the APFT, IAW FM 7-22
Yes
No
Within 30 days of class start date
PU (RAW)
SU (RAW)
RUN (TIME)
SCORE
AGE
DATE
MALE
SCORE
FEMALE
1. Soldier meets height / weight standards IAW AR 600-9
YES
NO
2. Soldier has a MEDPROS print out to verify a physical within 5 years
YES
NO
If over 40, physical must be within one year of class start
3. Soldier has a completed Physical Health Assesment (PHA)
YES
NO
4. Soldier has received 3 copies of orders
YES
NO
5. Soldier has a current / valid ID Card and ID Tags
YES
NO
6. Soldier has military specification eye glasses if needed
YES
NO
7. Soldier has all required equipment per WTC packing list
YES
NO
8. Soldier has received specific instructions for transportation
YES
NO
9. Soldier has emailed or faxed a flight itinerary to the hosting unit
YES
NO
10.Soldier is driving POV more than 100 miles
YES
NO
If driving more than 100 mi, Soldier will be required to stay over night after graduation
INITIAL
1st Line
COURSE INFORMATION
AIR ASSAULT COURSE
Soldier
CDR
Leader
COURSE #
Soldier received training on an Obstacle Course
LOCATION
Soldier conducted a 12 mile Foot March
Soldier is not on profile
REPORT DATE
Soldier has all required equipment and is serviceable
START DATE
INITIAL
END DATE
1st Line
COURSE INFORMATION
RAPPEL MASTER COURSE
Soldier
CDR
Leader
COURSE #
Soldier is a E-4 to O-2
LOCATION
Soldier is a graduate of Ranger, Sapper,
Air Assault or Mountaineering Course
REPORT DATE
INITIAL
START DATE
1st Line
END DATE
PATHFINDER COURSE
Soldier
CDR
Leader
COURSE INFORMATION
Soldier is an E3 - E7 or O1 - O3
COURSE #
If Soldier does not meet rank or MOS requirements,
LOCATION
a signed waiver from the IN Commandant must be present
Soldier is currently in or enroute to a F7 / 5Q position
REPORT DATE
MOS/Branch Qualifies for an ASI of F7 or 5Q
START DATE
Enlisted MOS: 11B, 11C,19D, 92R (Skill Level 3 or 4 Only), 92Y
END DATE
(Skill Level 1, 2 or 3 Only), 88M, 93C.
Officers Branches Only: IN, AR (Cavalry Only), MI, QM
(AOC 90A ONLY), or LG
PULHES
GT Score is 110 or greater
GT SCORE
I have completed all listed tasks as noted above and have all required documents listed above.
SOLDIER'S SIGNATURE
PRINTED NAME
DATE
COMMANDER CONTACT INFORMATION
OFFICE: (
)
CELL: (
)
EMAIL:
SIGNATURE
PRINTED NAME
DATE
1SG OR READINESS NCO CONTACT INFORMATION
OFFICE: (
)
CELL: (
)
EMAIL:
SIGNATURE
PRINTED NAME
DATE
FOR MORE INFORMATION VISIT:
https://
WTC FORM 100
FY2015
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