Administrative Seperation Checklist

CRIMINAL LAW OFFICE - ADMINISTRATIVE SEPARATION CHECKLIST All Documents Must be Submitted for Initiation of Any Chapter. Call 240-0909 for Assistance.

1. ___ Chapter Request Form 13. ___ Back-Up Copies (Mandatory) □ Select Type of Discharge Unit must maintain copies of all □ CDR Sign’s & Dates original documents. (Keep @ Unit) □ POC Information is Filled Out ------2. ___ Assumption of Command Orders Additional Documents for (If Applicable) Certain Chapters ------3. ___ Flag for Elimination – DA FM 268 (Only for Involuntary Chapters*) a. ___ Chapter 5-8: Family Care Plan Counseling & Checklist 4. ___ ERB □ No Older than 30 Days b. ___ Chapter 5-13 / 5-17: Ensure that □ Correct Rank MEDCOM Form 4038 under Fitness □ BA Flag Code (If Applicable) For Duty & Continued Service, Line □ All Awards (Update it) 4, is checked either Chapter 5-13 or □ Correct Promotion/Reduction 5-17 Dates c. ___ Chapter 5-16: Call us 240-0909 5. ___ Reenlistment Documents – 4/3 (If Applicable) d. ___ Chapter 6: Call us 240-0909

6. ___ Prior Service DA FM 1506 / DD FM e. ___ Chapter 8: Pregnancy Certificate, 214 (If Applicable) Counseling & Counseling Checklist

7. ___ Education Counseling (Mandatory) f. ___ Chapter 9: Letter from ASAP stating that the Soldier is a 8. ___ Counseling’s Pertaining To “Rehabilitation Failure” Chapter g. ___ Chapter 13 (APFT Failure): DA 9. ___ Misconduct (If Applicable) Form 705 for two consecutive □ Copy’s of Article 15 Packet Record APFT’s within 90 days □ MP and / or CID Reports □ Sworn Statements h. ___ Chapter 16: Call us 240-0909

10. ___ Medical Examination (Mandatory) i. ___ Chapter 18 Call 239-4736 / Bldg 7672 for Appt □ Weight Control Program Docs □ Medical Evaluation stating that: 11. ___ Mental Evaluation (Mandatory) “No Medical Conditions Exists” For Chapter 5-13, 13, 14, & 15: □ Nutrition Counseling Call 239-7208 for Appt □ Monthly Body Fat Worksheets - First Month to Current Month 12. ___ ASAP Documents (If Applicable) Required if Soldier was enrolled ------due to Drug / Alcohol related * Voluntary Chapters (No Flag): Offense 5-3, 5-4, 5-12, 5-16, 6-3a, 6-3b, 7-16, 8,16-1,16-2, 16-4, 16-6