NCOA STUDENT PERSONAL DATA XVIII AIRBORNE CORPS …
NCOA STUDENT PERSONAL DATA XVIII AIRBORNE CORPS AND FORT BRAGG NCO ACADEMY
FORT BRAGG, North Carolina 28310-5000
LAST NAME
FIRST NAME
M.I. / JR/II SSN
Gender
Rank
Home / Cell Phone#:
College Experience:
Date of Rank
Current # of promotion points
Current promotion Point Cut-off
GT Score:
5 Digit MOS:
Profile:
Type:
Field of Study:
College/University Attended:
CURRENT UNIT ASSIGNED:
CO/BTRY/TRP:
BN/SQD: BCT/BDE/GRP: DIVISION and MAJOR COMMAND:
CONTACT INFORMATION: (need rank, name, phone #, and email for everyone) SPONSOR:
PLATOON SERGEANT:
FIRST SERGEANT: BRIGADE CSM:
BN STAFF DUTY PHN #:
DATA REQUIRED BY THE PRIVACY ACT OF 1974 Title of Form: Student Personal Data Sheet Prescribing Directive: 10 USC 3012 Authority: 10 USC 3012 Routine Uses: Any information you provide is disclosable to members of the Department of Defense who have a need for the information in the performance of their duties. In addition the information may be disclosed to Government agencies outside the Department of Defense. Mandatory or Voluntary Disclosure and Effect of Individual not providing information: Providing the information is voluntary. Individuals not providing the requested informaiton will not be admitted into the course. I fully understand that providing false information on this form is a violation of the NCOA Honor Code and may result in my dismissal from the NCO Academy. Futhermore, I understand that if I am dismissed for providing false information I could be subject to the provisions of the UCMJ by my unit.
Student digital signature
21 APR 16 (All previous Versions are Obsolete)
UNIT PRE-EXECUTION CHECKLIST
(For use of this form, see TRADOC Regulation 350-18; Proponent is TRADOC G-3/5/7, TOMA)
Fillable form; may be printed and signed manually.
1. NAME: 2. UNIT:
3. COURSE TITLE:
Supervisor's Initials
Soldier's Initials
4. REPORT DATE: PART I- UNIT PRE-EXECUTION (Day-90 to Day-1) Coordination between unit and school to identify the Soldier by name and reservation status?
Soldier in receipt of read ahead packet, school/course information, and graduation requirements?
Soldier completed prerequisite course/testing? (DA Form 1059 or other completion document)
All required clothing/equipment in accordance with school/course information packet?
Soldier meets physical readiness standards of AR 350-1? (APFT within 60 days)
Soldier meets height/weight and body composition standards of AR 600-9?
Soldier has Government Travel Card or adequate cash/traveler checks?
Individual orders received (10 copies)?
Soldier has current periodic health assessment (PHA) and dental exam?
Soldier meets physical qualifications for special skills as specified in AR 40-501?
Soldier meets remaining Time in Service (TIS) requirement?
Transportation verified/DTS approved?
Soldier has current/valid identification card?
Soldier has ID tags (1 pair)?
Phone Number with Area Code
CDR Office: 1SG Office: FTM Office: Unit Fax:
Unit POC List:
Other: Other: Other:
1SG Email: CSM Email: TRADOC Form 350-18-2-R-E, APR 2018
Previous editions are obsolete
Page 1 of 2
TASK
Minimum Aptitude Score (if applicable)
PART II - ROUTINE PREREQUISITES
REGULATION DATA
SOLDIER DATA
CL CO EL FA GM CL CO EL FA GM
GT MM OF SC ST GT MM OF SC ST
Key: CL-Clerical/ADMIN; CO-Combat/CMBT; EL-Electronic/ELEC; FA-Field Artillery/FA; GM-General Maintenance/MAINT; GT-General Technical/GT; MM-Mechanical Maintenance/MECH; OF-Operators & Food/FOOD; SC-Surveillance & Communication/COMM; ST-Skilled Technical/TECH
Physical demand rating/profile (PULHES) *See Part Ill for PT profiles
P U L HES P U L HES
Key: P- Physical capacity/stamina; U- Upper extremities; L- Lower extremities; H- Hearing/ear; E- Eyes; S- Psychiatric
Military and civilian vehicle operator license(s) (if applicable): Military license number: Civilian license number:
Expiration date: Expiration date:
State:
PART Ill - REQUIRED DOCUMENTS
Security clearance (if applicable, attach as required)
*Permanent profile attendees must have a signed copy of completed DA Form 3349; must include Army doctorapproved alternate aerobic event for APFT. Provide results of medical retention board (if applicable).
All required waivers (if applicable) Other requirements (if applicable) Other requirements of DA PAM 611-21 not previously listed: Other requirements (if applicable) Other requirements (if applicable) Other requirements (if applicable) Other requirements (if applicable)
I have been counseled and have read all requirements applicable to the course I'm selected to attend. Attendance at this course and class will not pose any known hardship on me and/or my family that would detract from or prevent my successful completion of course requirements.
Student's Signature:
I have reviewed the above Soldier's qualifications and potential to successfully complete this course, counseled them on these requirements, and hereby verify their readiness to attend.
Commanding Officer (typed name):
Commanding Officer's Signature: TRADOC Form 350-18-2-R-E, APR 2018
Previous editions are obsolete
Page 2 of 2
XVIII Airborne Corps and Fort Bragg NCO Academy
Basic Leader Course (BLC) Packing List
MANDATORY, NON-SEASONAL ITEMS
1 OCP Uniform complete (see notation 3)
4SET
2 Set, Velcro nametag w/US Army (unless sewn on)
2EA
3 Set, Velcro US Flag
2EA
4 Set, Velcro Rank (unless sewn on)
2EA
5 Set, Velcro Unit patch
2EA
6 Cap, Patrol w/nametag and rank
1EA
7 Belt, Rigger, Tan/Coyote
1EA
8 Boots Combat, Tan/Coyote
2PR
9 Socks, Boot (Solid OD or Foliage Green, Brown or Black)
7EA
10 Undershirt (Sand/Tan 499)
7EA
11 Undergarments (if applicable)
7EA
12 Brassieres (if applicable)
7EA
13 Leather Work Gloves Initial Issued (Foliage Green or Black)
1EA
14 Light Weight Wool Glove Liner (Foliage Green, Black, Brown)
2EA
15 APFU Jacket
1EA
16 APFU Trousers
1EA
17 APFU T Shirt Long Sleeved
2EA
18 APFU T Shirt Short Sleeved
2EA
19 APFU Trunks w/liner
2EA
20 Socks, Athletic Calf or Crew Length (white or black)
7EA
21 Running Shoes
1PR
22 Black Cap, Synthetic Micro Fleece
1EA
23 Towel Brown or Neutral Color
2EA
24 Wash Cloth Brown or Neutral Color
2EA
25 Wet/Cold Weather Jacket and Trousers
1PR
26 ASU (jacket/trousers, for male/female)
1EA
27 ASU Shirt/LS
1EA
28 ASU Shirt/SS
1EA
29 All Weather Coat with Rank for male/female
1EA
30 Black Four Hand Tie (male)
1EA
31 Beret, Organizational (w/DUI)
1EA
32 Black Neck Tab (female)
1EA
33 Belt Web w/Brass Tip
1EA
34 Buckle Solid Brass
1EA
35 Shoes, Black Oxford Low Quarters or Jump Boots (unit dependent) 1PR
36 Undershirt, White (male)
2EA
37 Socks, Dress Black
2PR
38 Name Plate
2EA
39 All authorized awards & accoutrements (IAW with SRB)
1EA
40 Civilian attire, casual wear (if TDY)
2PR
41 Dress Gloves, Unisex Military Issue
1PR
42 Duffle Bag
1EA
43 Barracks Bag
1EA
44 Head Lamp or L Shaped Flashlight (red/clear lens w/2 sets of
1EA
45 Identification Card (CAC)
1EA
46 Identification Tags with SM/LG Chain
1PR
47 Personal Hygiene/Shaving Kit Complete
1EA
48 Army Approved Eye Protection
1SET
49 FLC set up complete w/ all issued pouches
1SET
50
Tactical Back Pack or Assault Pack (foliage green, solid black, OCP pattern, coyote brown)
1EA
51 PT Belt
1EA
52 Military Issued Water Source (Camelback)
1EA
53 MREs
2EA
SEASONAL/COLD WEATHER CLOTHING (1 OCT - 1 APR)
1 Level I Light Weight Shirt & Drawers (Silk Top/Bottoms)
2PR
2 Level II Mid Weight Shirt & Drawers (Waffle Top/Bottoms) 1PR
CLASSSROOM ITEMS NEEDED
1 Blank Rewritable CD Media
4EA
2 Composition Note books College or Wide ruled
3EA
3 Protractor, GTA 05-02-012
1EA
4 Pencil, Mechanical .5mm
2EA
5 Pens, Black
2EA
6 Zip Lock Bags M/L
1BX
7 Eye Glasses (if applicable)
2SET
8 Wrist Watch
1EA
9 Military Compass, Lensatic
1EA
10 3X5 Note Cards
1PK
SUGGESTED OR OPTIONAL ITEMS
1 Hangers Plastic or Wire
10EA
2 Highlighter Markers (HI-LITER)
2EA
3 Insect Repellent
1EA
4 Sun Screen
1EA
5 Sewing Kit Complete
1EA
6 Dress Uniform Measurement Tool & Guide Book
1EA
7 Leaders Book Complete
1EA
8 Locks with two keys, or Combination Locks
3EA
9 Laundry Detergent Liquid, Powder or Pods
1PK
10 1-1/2 Inch Binder with Document Protectors
1SET
11 Pocket Note Pad
1EA
NOTES:
1. Army Service Uniform (ASU) must include 2 x name plates, branch insignia, all authorized ribbons and decorations, 2 x Unit Crests, special Skill Badges/Combat Badges (if authorized). All items for Infantry personnel are authorized as well as Foreign Badges and Unit Awards. Marksmanship and Driver Badges are also authorized. Soldiers will arrive to BLC with their Dress Uniform properly fitted, clean, pressed and presentable, with all awards, decorations, badges, and name plates affixed.
2. Students will bring the Oxford Low Quarter Dress Shoes for inspection purposes. Unit Authorization footwear will be worn for graduation if conducted in ASU 3. All students are required to have two complete sets of accoutrements for their OCP uniform; including Velcro unit patches, rank, nametapes and U.S. Army tapes, along with subdued skill and occupation badges (if applicable). The U.S. embroidered-colored insignia flag is the only authorized insignia. The U.S. Army & nametapes, rank, and special skill badges MAY be sewn on uniforms as an alternative to Velcro insignias.
4. All uniforms and uniform components brought for wear and layout purposes must be clean and serviceable. At no time will soldiers bring uniforms or uniform components that are faded or have holes, rips, tears, stains, dirty and/or missing pieces of the component.
5. Cold weather equipment will vary by installation, regional conditions, and availability of ECWCS equipment. Not all installations are issued the same cold weather gear; seasonal temperattures, the installation andd NCOA policies regulate the appropriate equipment needed in cold climates during the course.
I acknowledge that the items listed in this packing list have been laid out and inspected prior to arrival at the BLC. Furthermore, I understand that if any deficiencies are annotated during the initial layout of this equipment, I will have no more than 72 hours from the time of the initial layout to fix the deficiency, or be recommended to the Commandant for dismissal from the BLC IAW the approved Course Management Plan (CMP) dated January 2019. Lastly, I confirm that I have a CAC card with a working pin and am able to access my military email account.
____________________________________________ Student Signature
____________________________________________ First Line Supervisor
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