Form Navpers 5350/3 - Dapa Admin Screening Form - Navpers Form Page 7
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10DAPA ADMIN SCREENING FORM
Servicemember Name
13. Drug and Alcohol Education
Evidence of attendance at:
NASAP
Yes
No
NADSAP
Yes
No
PREVENT
PREVENT 2000
Yes
No
Yes
No
ADAMS (Supervisor)
ADAMS (Manager)
Yes
No
Yes
No
Other training (GMT etc)
AWARE
Yes
No
Yes
No
If yes to any course, provide details including date, location and if member attended due
to alcohol related incident.
14. Security Clearance:
downgraded
removed
access denied
special handling
If any of these, describe circumstances:
15. Is DD-1966 located in service record?
Yes
No
List prior civilian employment including dates of employment:
Pre-service arrests/charges/court actions/convictions (provide dates and description of
circumstances):
Additional information found on DD-1966:
r
DAPA Name
Phone Numbe
NAVPERS 5350/3 (Revised 08-09)
FOR OFFICIAL USE ONLY
PAGE 7 OF 10
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