Fillable Form 3838 - Application For Short Course Training printable pdf download

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)

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.

Form 3838 - Application For Short Course Training

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