Nrotc Unit, the University of Arizona

NROTCUA FORM 1336/1

(Rev. 4/03)

NROTC UNIT, THE UNIVERSITY OF ARIZONA

Name:-- Rank --MIDN 1st ClassMIDN 2nd ClassMIDN 3rd ClassMIDN 4th ClassGYSGTSSGTSGTCPLOCLAST, FIRSTMI

SPECIAL REQUEST/AUTHORIZATION

Company/Platoon:AlphaBravoBatt. Staff 1PC1DC/PS1-11-21-32PC2DC/PS2-12-22-33PC3DC/PS3-13-23-3Staff

NAVY OPTION

Date/Time of Request:HHmm yyyymmdd

Nature Of Request: Absence Request: Other (SPECIFY):

Reason/Explanation For Request:

NOTE: BE BRIEF AND PROVIDE ALL PERTINENT DETAILS (I.E. DATES, ACTIVITIES, ETC.)

PLATOONALPHA-1ALPHA-2ALPHA-3BRAVO-1BRAVO-2BRAVO-3 APPROVAL

-- Billet --Squad LeaderPlatoon CommanderCompany CommanderBn StaffBattalion XOBattalion CommanderMOIXOCO: -- Rank --MIDN 1st ClassMIDN 2nd ClassMIDN 3rd ClassMIDN 4th ClassGYSGTSSGTSGTCPLOCCAPTCDRMAJLTLAST, FIRSTMI

Comments:

Recommended Approval? Yes No Date/Time of Approval:HHmmyyyymmdd

PLATOONALPHA-1ALPHA-2ALPHA-3BRAVO-1BRAVO-2BRAVO-3 APPROVAL

-- Billet --Squad LeaderPlatoon CommanderCompany CommanderBn StaffBattalion XOBattalion CommanderMOIXOCO: -- Rank --MIDN 1st ClassMIDN 2nd ClassMIDN 3rd ClassMIDN 4th ClassGYSGTSSGTSGTCPLOCCAPTCDRMAJLTLAST, FIRSTMI

Comments:

Recommended Approval? Yes No Date/Time of Approval:HHmmyyyymmdd

COMPANY APPROVAL

-- Billet --Squad LeaderPlatoon CommanderCompany CommanderBn StaffBattalion XOBattalion CommanderMOIXOCO: -- Rank --MIDN 1st ClassMIDN 2nd ClassMIDN 3rd ClassMIDN 4th ClassGYSGTSSGTSGTCPLOCCAPTCDRMAJLTLAST, FIRSTMI

Comments:

Recommended Approval? Yes No Date/Time of Approval:HHmmyyyymmdd

BATTALION APPROVAL

-- Billet --Squad LeaderPlatoon CommanderCompany CommanderBn StaffBattalion XOBattalion CommanderMOIXOCO: -- Rank --MIDN 1st ClassMIDN 2nd ClassMIDN 3rd ClassMIDN 4th ClassGYSGTSSGTSGTCPLOCCAPTCDRMAJLTLAST, FIRSTMI

Comments:

Recommended Approval? Yes No Date/Time of Approval:HHmmyyyymmdd

BATTALION APPROVAL

-- Billet --Squad LeaderPlatoon CommanderCompany CommanderBn StaffBattalion XOBattalion CommanderMOIXOCO: -- Rank --MIDN 1st ClassMIDN 2nd ClassMIDN 3rd ClassMIDN 4th ClassGYSGTSSGTSGTCPLOCCAPTCDRMAJLTLAST, FIRSTMI

Comments:

Recommended Approval? Yes No Date/Time of Approval:HHmmyyyymmdd

FINAL APPROVAL AUTHORITY

-- Billet --Squad LeaderPlatoon CommanderCompany CommanderBn StaffBattalion XOBattalion CommanderMOIXOCO: -- Rank --MIDN 1st ClassMIDN 2nd ClassMIDN 3rd ClassMIDN 4th ClassGYSGTSSGTSGTCPLOCCAPTCDRMAJLTLAST, FIRSTMI

Comments:

FINAL APPROVAL? Yes No

SignatureDate