Military Service Separation Explanation Form
Please provide details about your military service separation to assist with the review process. Do not include any sensitive identification numbers, medical or health information, or financial data.
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
Marine Corps
Coast Guard
Space Force
Other
Final Rank/Grade at Separation
Dates of Service (Start and End)
*
Type of Separation
*
Please Select
Honorable
General (Under Honorable Conditions)
Other Than Honorable
Bad Conduct
Dishonorable
Medical
Other
Reason for Separation
*
Please Select
End of Contract
Retirement
Administrative Discharge
Misconduct
Performance
Medical (Non-sensitive, do not specify details)
Other
Please explain the circumstances of your separation
*
Upload supporting documents (if any, do not include sensitive or medical records)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Submit Explanation
Should be Empty: