Military Drug Waiver Request Form
Submit this form to request a waiver for a drug-related incident in accordance with military policy. All information provided will be used to evaluate your request.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Branch of Service
*
Please Select
Army
Navy
Air Force
Marines
Coast Guard
Space Force
Other
Rank/Grade
*
Please Select
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
Other
Date of Drug-Related Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type of Substance Involved
*
Please Select
Marijuana
Cocaine
Prescription Medication (Misuse)
Amphetamines
Opiates
Other
Brief Description of Incident and Circumstances
*
Have you had any prior drug-related incidents?
*
No
Yes
Reason for Requesting Waiver
*
Submit Waiver Request
Should be Empty: