Military Personnel Status Change Form
Report a change in duty or administrative status. Please complete all required fields accurately.
Full Name
*
First Name
Last Name
Rank
*
Service Number
*
Current Unit or Assignment
*
Type of Status Change
*
Please Select
Change of Duty
Administrative Leave
Temporary Duty Assignment
Return from Leave
Other
Effective Date
*
-
Month
-
Day
Year
Date
Reason or Remarks
Command Point of Contact Name
*
Command Point of Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Command Point of Contact Email
example@example.com
Submit Status Change
Should be Empty: