Military Personality Disorder Waiver Form
Provide the information needed to request review of a military personality disorder waiver. Use the exact title consistently throughout the form.
Applicant Information
Applicant's Full Legal Name
*
First Name
Middle Name
Last Name
Branch of Service
*
Please Select
Army
Navy
Air Force
Marine Corps
Space Force
Coast Guard
Other
Rank / Grade
*
Current Duty Status
*
Please Select
Active Duty
Reserve
National Guard
Separated
Retired
Other
Waiver Review Details
Waiver Request Reason
*
Diagnosis or Condition Summary
*
Date of Diagnosis or First Evaluation
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Treatment Status
*
Please Select
Not in treatment
In treatment
Completed treatment
Other
Supporting Documentation
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Waiver Acknowledgment
Applicant Signature
*
Submit Form
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