<p> Special Request/Authorization Chit</p><p>Directions for filling out Special Request Chit:</p><p>Block 1 – NAME Student’s last name, first name, middle initial, and suffix, if any, separated by spaces. Place a comma after the last name and a period after the middle initial. ALL CAPS. Examples: SMITH, JOHN A. OBRIEN, SUSAN J., III JOHNSON, JACK J., JR HALL, BETTY</p><p>Block 2 – RATE Enter your abbreviated rank. Examples: MIDN OC SSgt</p><p>Block 3 – SHIP OR STATION This is uniform for everyone. Do not deviate from the example below. Example: NORTHWESTERN NROTC </p><p>Block 4 – DATE OF REQUEST Enter the date. Date must be written in YYYYMMMDD format. Example: 2015SEP03</p><p>Block 5 – DEPARTMENT/DIVISION Enter your platoon assignment here. ALL CAPS. Examples: 1ST PLATOON STAFF</p><p>Block 6 – DUTY SECTION/GROUP Enter your squad assignment here. ALL CAPS. Examples: 1ST SQUAD 2ND SQUAD ACADO/PTI/XO</p><p>Block 7 – NATURE OF REQUEST Mark the appropriate box indicating the appropriate nature of your request. All indications must include a detailed, explicit reasoning for your request in the box labeled “REASON FOR REQUEST.”</p><p>Most Common Reasons: LEAVE – going on vacation for spring break, visiting a friend at another school for the weekend, etc. CONFLICT – missing an ROTC event (PT, Naval Science, etc.) due to class trip, leave, etc. OTHER – changing out of the UOD early for a science lab, etc. </p><p>Block 8 – NO. of DAYS REQUESTED Enter the approximate of days you are requesting to be on leave with only a number. Example: 9</p><p>FROM (DATE & TIME) Enter the date you will be leaving from your residential (at school) area. Date must be written in YYYYMMMDD format. This must also include an approximate time using the standard 24-hour military time. The date and time will be separated by a diagonal line. Example: 2015SEP03/0815</p><p>TO (DATE & TIME) Enter the date you will be returning to your residential (at school) area. Date must be written in YYYYMMMDD format. This must also include an approximate time using the standard 24-hour military time. The date and time will be separated by a diagonal line. Example: 2015SEP11/1500</p><p>Block 9 – DISTANCE - (MILES) Enter the approximate number of miles from your residential area to your appropriate destination. This only applies towards to requesting leave that is beyond the 200 mile radius of your residential area. Enter only with a number. Example: 2076</p><p>MODE OF TRAVEL Indicate the mode of transportation. This only applies towards requesting leave that is beyond the radius of your residential area.</p><p>Block 10 – LEAVE ADDRESS Enter the leave address of your appropriate destination. Enter the street address with any cardinal directions abbreviated (i.e. S Wabash as opposed to South) and the street designation spelled out (i.e. Lane as opposed to Ln.) and skip a space. Enter any mailbox numbers as pound and then the number followed by a space (#007), apartment numbers as Apt. followed by the apartment number and a space (Apt. 2B), or P.O. box numbers as P.O. Box followed by a space and then pound and the numbers followed with a space (P.O. Box #1776 ). Enter the city followed by a comma, space, the 2 letter state abbreviation, space, and five-digit zip code. ALL CAPS Example: 617 HAVEN STREET EVANSTON, IL 60201</p><p>Block 11 – TELEPHONE NUMBER You MUST enter a telephone number for your home of record and it is preferred that if you have a cellular phone, it be entered as your local. Enter your 3 digit area code and 7 digit phone number in the format of ###-###-####. Example: 123-456-7890</p><p>Block 12 – REASON FOR REQUEST Provide a DETAILED explanation on the reasoning of your chit request and respectfully requesting for an excuse absence or permission for your leave. ALL CAPS. Example: I, MIDN DOE, RESPECTFULLY REQUEST PERMISSION TO TRAVEL OUTSIDE OF MY RESIDENTIAL RADIUS FROM 2015SEP03 TO 2015SEP11 TO VISIT MY FAMILY IN CALIFORNIA FOR MY FATHER’S BIRTHDAY. </p><p>Block 13 – SIGNATURE OF APPLICANT Enter your signature along with the date of request with black ink. Date must be written in YYYYMMMDD format.</p><p>Block 14 – If you have a certain duty during the time you are requesting special leave, have them sign and put their duty station just as you would in Block 6. THIS IS VERY RARE, THOUGH. OTHERWISE, JUST LEAVE THIS BLOCK BLANK. IF YOU HAVE ANY DOUBT OR UNCERTAINTY REGARDING THIS, CONTACT THE ADJUTANT DIRECTLY.</p><p>IF INCLUDING AN ENCLOSURE, THE LAST SENTENCE IN THE REASON FOR REQUEST SHOULD SAY EXACTLY: “SEE ENCLOSURE (1).” IF THERE ARE MULTIPLE ENCLOSURES, WRITE: “SEE ENCLOSURES (1), (2), AND (3).” </p><p>THE ACTUAL ENCLOSURE SHOULD HAVE THE FOLLOWING IN THE TOP LEFT CORNER: </p><p>ENCLOSURE (1) MIDN 2/C KEARNEY</p>