Military Conditional Release Request Form
Submit your request for conditional release from military service. Please complete all required sections accurately.
Applicant Full Name
*
First Name
Last Name
Rank/Grade
*
Military Unit/Division
*
Service Number (if applicable)
Current Duty Station
*
Military Contact Email
*
example@example.com
Military Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Reason for Conditional Release Request
*
Requested Release Start Date
*
-
Month
-
Day
Year
Date
Requested Release End Date
*
-
Month
-
Day
Year
Date
Supervisor's Name and Contact Information
*
Civilian Contact Email (for follow-up)
*
example@example.com
Additional Comments or Supporting Information (optional)
Signature of Applicant
*
Submit Request
Submit Request
Should be Empty: