Dd Form 1746 Draft - Application For Assignment To Housing Page 2
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5APPLICATION FOR ASSIGNMENT TO HOUSING
1. TYPE SERVICE DESIRED
(X one or both)
(Before completing form, read Privacy Act Statement and Instructions on reverse)
a. MILITARY HOUSING
b. HOUSING REFERRAL
SECTION I - APPLICANT INFORMATION
2. NAME OF SPONSOR
(Last, First, Middle Initial)
3. PAY GRADE
4. SSN
5. DOD COMPONENT
6. ADDRESS
(Street, City, State, Zip Code)
7. TELEPHONE NUMBER
8. STATUS OF APPLICANT
(X one)
a.
HOME (Area Code)
b. DUTY (DSN)
a. MILITARY MEMBER
c. CIVILIAN
b. MILITARY SPOUSE
d. FOREIGN NATIONAL
9. MARITAL STATUS
10. I AM SEPARATED FROM MY DEPENDENTS
(X one)
a. VOLUNTARILY
b. INVOLUNTARILY
11. I REQUEST HOUSING FOR
(X one)
SECTION II - MILITARY CAREER INFORMATION
(Civilians skip to Item 15.)
a. SELF ONLY
b. SELF AND DEPENDENTS
14. DATES
(Enter in YYMMDD order)
MILITARY APPLICANT
MILITARY SPOUSE
12. INSTALLATION/ORGANIZATION TRANSFERRED FROM
a. EFFECTIVE RANK/RATE DATE
b. ACTIVE DUTY SERVICE COMPUTATION
c. TIME REMAINING ON ACTIVE DUTY
13. INSTALLATION/ORGANIZATION TRANSFERRED TO
d. EFFECTIVE CHANGE IN DUTY STATION
e. REPORT DATE
f. ESTIMATED FAMILY ARRIVAL DATE
SECTION III - DEPENDENT DATA
(If more space is needed, continue on plain paper.)
15. DEPENDENTS RESIDING WITH ME
b. DATE OF BIRTH
e. REMARKS (Handicap, health problems, expected additions to
a. NAME (Last, First, Middle Initial)
c. SEX
d. RELATIONSHIP
(YYMMDD)
family, etc.)
SECTION IV - HOUSING DATA
16. COMMUNITY HOUSING DESIRED
(X as applicable)
a. PURCHASE HOUSE
d. RENT HOUSE
g. RENT MOBILE HOME SPACE
j. ROOM AND BOARD
b. PURCHASE CONDOMINIUM
e. RENT APARTMENT
h. SHARE
k. SUBLET
c. PURCHASE MOBILE HOME
f. RENT MOBILE HOME
i.
RENT ROOM
l. TRANSIENT
18. DATE HOUSING NEEDED
19. PRICE RANGE
17. AMENITIES DESIRED
(X as applicable. Write number in d. and e.)
(YYMMDD)
(Community Housing)
a. FURNISHED
e. NO. BATHS
b. UNFURNISHED
f. PETS (Allowed)
20. LOCATION PREFERENCE
(Community Housing)
g. OTHER (Explain)
c. AIR CONDITIONING
d. NO. BEDROOMS
21. REMARKS
I GIVE THE HOUSING OFFICE PERMISSION TO RELEASE MY INFORMATION TO THE PROPERTY OWNER.
22. SIGNATURE OF APPLICANT
23. DATE SUBMITTED
(YYMMDD)
SECTION V - DISPOSITION
(To be completed by the Housing Office.)
24. MILITARY HOUSING
a.
APPLICATION RECEIVED
c. DD FORM 1747 PROVIDED
d.
HOUSING AVAILABILITY (Boxes
b. APPLICATION EFFECTIVE (YYMMDD)
(YYMMDD and time)
(YYMMDD)
indicated on DD Form 1747)
e.
APPLICANT PLACED ON WAITING LIST
f. EFFECTIVE PLACEMENT (YYMMDD)
g. BEDROOMS REQUIRED
h.
DATE UNIT ASSIGNED (YYMMDD)
SECTION VI - HOUSING REFERRAL CERTIFICATE
On this date I have received a listing of the housing restrictions approved
In addition, if any facility refuses to rent or sell to me or I have
by the Installation Commander, and I will not reside in any property on the
reason to believe I am being discriminated against, I will promptly notify
restricted list. I have been briefed on (1) the services provided by the
the Housing Office.
Housing Office, (2) the DoD program on equal opportunity for military
25. SIGNATURE OF APPLICANT
26. DATE SIGNED
personnel in off-base housing, and (3) nondiscrimination based on physical
(YYMMDD)
or mental handicaps.
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DD Form 1746, SEP 93
Previous editions may be used.
Adobe Professional 8.0
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