Form 131-R - Cadet Action Request (Page 2 of 2) in pdf

Form 131-R - Cadet Action Request Page 2

SECTION III – (CONTINUATION)

13. BATTALION COMMANDER/PMS CERTIFICATION AND RECOMMENDATION:

I certify that the cadet enrollment and retention information submitted with this request is accurate and complete. This action

request has been reviewed and is complete in accordance with Cadet Command PAM 145-4.

I recommend the following action be taken: (Check Appropriate)

Approval

Disapproval

Forward for Determination

Other ________________

Remarks:

14. COMMANDER/AUTHORIZED REPRESENTATIVE

15. DATE

(Typed Name and Signature)

SECTION IV – REMARKS (Applies to Section II) (WAIVER OF RIGHTS ONLY)

16. Under the provisions of Army Regulation 145-1, paragraph 3-43a(

), disenrollment from the ROTC program is initiated

due to the cadet’s breach of the Army Senior Reserve Officers’ Training Corps (ROTC) Scholarship Cadet Contract, DA 597-3,

based on (insert reason, i.e. academic GPA failure).

_____ Notification /Acknowledgment/Memo ref: Disenrollment

_____ Transcript

_____ Notification of Funds Expended (Amount e-mailed from HQCC, RMD)

_____ Class Roster

_____ Special Active Duty Provision (CC FM 213-R, Jul 99)

_____ APFT/Weight Body Fat Worksheet

_____ Privacy Act Release Statement (CC FM 133-R, Jul 94)

_____ Court Documentation

_____ Other (Specify):_____________

RECOMMEND APPROVAL

RECOMMEND MONETARY PAYBACK

RECOMMEND ACTIVE DUTY

Remarks:

I certify that the waiver of rights documentation has been completed IAW CC PAM 145-4. Copies of the documentation and/or

supporting documents as indicated above have been provided to the cadet and the cadet has been afforded an opportunity to

comment. The documentation will be maintained in the cadet’s Military Personnel Records Jacket and becomes a part of the

official personnel records as confirmation of disenrollment, obligation, and agreements.

18. DATE

17. PMS/BATTALION COMMANDER

(Typed Name and Signature)

ROTC Cadet Command Form 131-R, Nov 99

Previous edition obsolete

Form 131-R - Cadet Action Request Page 2