Form 4762 - Athlete'S Application
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1ATHLETE'S APPLICATION
For use of this form, see AR 215-1; the proponent agency is OACSIM.
10 U.S. Code 3013, and PL 11, 84th Congress.
AUTHORITY:
To evaluate applications by athletes for acceptance in inter-service, national, and international
PRINCIPAL PURPOSE:
competitions, including the Olympic Games.
To determine eligibility of athletes for amateur sports participation.
ROUTINE USES:
DISCLOSURE:
Disclosure of information is voluntary. However, failure to disclose information would result in
non-selection.
1. NAME (Last, First, MI)
2. RANK
3. DUTY PHONE (Autovon)
4.
SSN
5.
MOS
6.
AGE
7.
SEX
8.
HEIGHT
9.
WEIGHT
10.
DEROS DATE
11.
CURRENT UNIT MAILING ADDRESS AND INSTALLATION (Complete/NO Abbreviations)
DATE OF COMPLETION OF
DATE BASIC MILITARY
12.
SPORT AND POSITION FOR WHICH QUALIFIED
13.
14.
CURRENT TERM OF
TRAINING WAS COMPLETED
SERVICE/CATEGORY EXPIRATION
15.
SUPPORTING EXPERIENCE (Use this space and additional sheets, if necessary, to list supporting experience, i.e., event, date, place, and
performance in each case. A separate application is required for each sport.)
I Understand and Will Comply with the Army's Policy Concerning use of Performance-Enhancing Drugs as Prescribed in AR 215-2, Para
16.
6-3g (21) Volunteer to Train for and, If Selected, Represent the Army, Armed Forces, and/or the United States in Sports Competition.
17.
SIGNATURE OF APPLICANT
18.
DATE
19.
COMMANDER'S ACTION ON RELEASE TO PARTICIPATE IF SELECTED
APPROVAL
DISAPPROVAL
20a.
PRINTED NAME OF COMMANDER
20b.
RANK
20d.
DATE
20c.
SIGNATURE OF COMMANDER
DA FORM 4762, JUN 2004
APD LC v1.01ES
DA FORM 4762-R, AUG 90 IS OBSOLETE
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