Tradoc Form 350-6-2-R-E Initial Military Training (Imt) Soldier Assessment Report

INITIAL MILITARY TRAINING (IMT)

SOLDIER ASSESSMENT REPORT

(For use of this form see TRADOC Reg 350-6; the proponent agency is DCG-IMT)

PRIVACY ACT NOTICE

DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY:

Title 5, United States Code, Section 301, Departmental Regulations; Title 10, United States Code, Section 3013, Secretary of the Army.

PRINCIPAL PURPOSE: To assist leaders in verifying enlistment eligibility and in identifying Soldier leadership and personal readiness issues having a

predictable, direct, and substantial impact on initial entry training.

ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. 522a(b) of the Privacy Act, these records or information contained

therein may specifically be disclosed outside the DOD as routine use pursuant to 5 U.S.C. 552a(b)(3) and published at

DISCLOSURE: Disclosure of this information is voluntary. Failure to provide the requested information will hinder processing of official training related

functions.

PART 1 - ADMINISTRATIVE DATA

(Record pertinent administrative data on Soldier)

c. DATE (YYYYMMDD)

a. NAME

(Last, First, Middle Initial)

b. PMOSC

RECEPTION DS:

BCT DS:

AIT PSG:

UNIT:

START DATE:

E-MAIL ADDRESS:

PHONE:

PART II - PERSONAL DATA

(Initiated by Reception, updated at BCT or OSUT and AIT)

1. FAMILY/FINANCIAL STATUS: List any information that would affect/distract Soldier from training success (e.g., financial issues ______, Exceptional

Family Member Program (EFMP) _______, sole provider for family ________, military affiliation ________, family tragedy within the past year _______).

2. EDUCATION STATUS: List highest educational level attained and date it was attained (high school graduation date ________, years of college

________, vocational school ________). List vocational training, unique job experiences, and last three jobs.

3. LEADERSHIP EXPERIENCE IN PRE-ACCESSION (AS DESCRIBED BY RECRUIT AND IN IMT). List any positions of leadership such as Squad

Leader, Platoon Guide, ROTC, Police Explorers, Boy Scouts/Girl Scouts, Prior Service, etc.

4. LANGUAGE SKILLS OR BARRIERS: Identify and explain any language skills or barriers, either oral or written.

5. WEIGHT CONTROL/FITNESS LEVEL OR CONDITIONS THAT COULD AFFECT SOLDIER TRAINING. Beginning BCT Height _______ Weight

_______ Beginning AIT Height _______ Weight ________ Dental category _______ Profile Data: Profile Type _______ Profile Limitations ________

Exp Date _______

ARMY PHYSICAL FITNESS TEST

BASIC RIFLE MARKSMANSHIP

BCT/OSUT APFT #

AIT/OSUT APFT #

Combat Familiarization Fire

Qual Day 1

Qual Day 2

1 - 1 - 1

EVENT

RAW

SCORE

EVENT

RAW

SCORE

PUSH-UPS G / NG

PUSH-UPS

Additional MOS-related certifications:

SIT-UPS

G / NG

SIT-UPS

1 MI RUN

G / NG

2 MI RUN

DATE

TOTAL

DATE

TOTAL

TIME

CLS CERTIFICATION DATE: ____________

AIT MODULE TEST SCORES:

______________ DATE

TRADOC Form 350-6-2-R-E, NOV 2010

8.5X11

Tradoc Form 350-6-2-R-E Initial Military Training (Imt) Soldier Assessment Report - Army

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