Form 3838 - Application For Short Course Training

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DATE
APPLICATION FOR SHORT COURSE TRAINING
For use of this form, see AR 351-3; the proponent agency is the Office of The Surgeon General
PRIVACY ACT STATEMENT
1. AUTHORITY: 10 USC Section 3013, Secretary of the Army; AR 351-3, Professional Education and Training Programs of the Army Medical
Department; and E. O. 9397 (SSN).
2. PRINCIPAL PURPOSE(S): To obtain data needed to determine eligibility for enrollment, process applications, maintain student records, and to
perform all other administrative functions inherent in student administration.
3. ROUTINE USES: None. The "Blanket Routine Uses" set forth at the beginning of the Army's Compilations of System of Records Notices apply
to this system.
4. MANDATORY OR VOLUNTARY DISCLOSURE: Voluntary. However, failure to provide the requested information may result in the applicant
not being able to participate in the program.
TO:
FROM:
I. GENERAL INFORMATION
1. NAME (Individual Requesting Training)
2. SSN
3. RANK
4. SECURITY
5. CORPS/
6. MOS/AOC
CLEARANCE
BRANCH
7. UNIT AND STATION (Address and Zip Code)
8. UIC
9. DUTY POSITION
10. CATEGORY OF SERVICE
REGULAR ARMY
RESERVE
11. OFFICE PHONE
12. OFFICE FAX
13. HOME PHONE
14. AKO E-MAIL ADDRESS
(Include area code and DSN)
(Include area code)
(Include area code)
II. TRAINING INFORMATION
15. TYPE OF FACILITY SPONSORING TRAINING (Check applicable box)
16. DATES OF COURSE EXCLUDING
17. PROFESSIONAL LICENSE
TRAVEL TIME(Day, Month, Year)
(List any required for requested
CIVILIAN INSTITUTION (non-Federal)
course)
FEDERAL FACILITY
FROM:
AMEDD
ARMY(Less AMEDD)
TO:
OTHER MILITARY(Air Force, Navy, etc.)
NON-MILITARY(PHS, VA, etc.)
18. NAME OF COURSE REQUESTED (Attach
19. LOCATION OF COURSE (Include address and
20. LIST COSTS AS APPLICABLE
copy of course brochure)
zip code)
REGISTRATION
TUITION
OTHER
21. COURSES TAKEN (Include courses in both federal facilities and civilian institutions that have been taken
22. DATE OF MOST RECENT
during the current year and prior fiscal year. Include source of funding, e.g., local, AC, OTSG, and AMEDD C&S
CBRNE TRAINING
Central Training Program. If none, so indicate)
23. SIGNATURE (Applicant)
24. DATE
III. TRAINING APPROVAL
25. LOCAL APPROVING AUTHORITY (Check appropriate box and add remarks if applicable)
I RECOMMEND APPROVAL
I DO NOT RECOMMEND APPROVAL
26. NAME, GRADE, BRANCH AND TITLE
27. SIGNATURE (Local Approving Authority)
28. DATE
APD LC v1.02ES
DA FORM 3838, SEP 2007
EDITION OF NOV 1982 IS OBSOLETE.

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