CIVILIAN INSTITUTION ACADEMIC EVALUATION REPORT
For use of this form, see AR 623-3; the proponent agency is DCS, G-1.
SECTION I - ADMINISTRATIVE DATA
(To be completed by the student detachment or Installation Education Services Officer)
1. LAST NAME - FIRST NAME - MIDDLE INITIAL
7. APPLICABLE REGULATION
8. THIS IS A REFERRED REPORT, DO YOU WISH TO MAKE COMMENTS?
9. DURATION OF COURSE (YYYYMMDD)
SECTION II - EVALUATION
ATTACH AN OFFICIAL TRANSCRIPT IN DUPLICATE
(To be completed by the Civilian Institution)
10. NAME AND ADDRESS OF CIVILIAN INSTITUTION
11. EVALUATION (Evaluation of Student Performance should be based on the normal standard of performance at the institution. Identify the
discipline of study, degree, and any special achievements or deficiencies noted, etc. Include aptitude for further schooling.)
TYPED NAME, TITLE AND TELEPHONE NUMBER
SECTION III - ADMINISTRATIVE REVIEW
(To be completed by the Reviewer)
12. DID STUDENT SUCCESSFULLY COMPLETE THE COURSE?
(A "NO" response must be supported by comments in ITEM 13. An Official Transcript must
be attached prior to submission of the report to the OMPF.)
13. REVIEWER COMMENTS
TYPED NAME AND TITLE
SIGNATURE RATED SOLDIER
DA FORM 1059-1, MAR 2006
PREVIOUS EDITIONS ARE OBSOLETE.