For use of this form, see AR 215-1; the proponent agency is OACSIM.
10 U.S. Code 3013, and PL 11, 84th Congress.
To evaluate applications by athletes for acceptance in inter-service, national, and international
competitions, including the Olympic Games.
To determine eligibility of athletes for amateur sports participation.
Disclosure of information is voluntary. However, failure to disclose information would result in
1. NAME (Last, First, MI)
3. DUTY PHONE (Autovon)
CURRENT UNIT MAILING ADDRESS AND INSTALLATION (Complete/NO Abbreviations)
DATE OF COMPLETION OF
DATE BASIC MILITARY
SPORT AND POSITION FOR WHICH QUALIFIED
CURRENT TERM OF
TRAINING WAS COMPLETED
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
6-3g (21) Volunteer to Train for and, If Selected, Represent the Army, Armed Forces, and/or the United States in Sports Competition.
SIGNATURE OF APPLICANT
COMMANDER'S ACTION ON RELEASE TO PARTICIPATE IF SELECTED
PRINTED NAME OF COMMANDER
SIGNATURE OF COMMANDER
DA FORM 4762, JUN 2004
APD LC v1.01ES
DA FORM 4762-R, AUG 90 IS OBSOLETE