NCOA STUDENT PERSONAL DATA XVIII AIRBORNE ... - …

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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