NCOA STUDENT PERSONAL DATA DEPARTMENT OF THE ARMY XVIII AIRBORNE CORPS AND FORT BRAGG NONCOMMISSIONED OFFICERS ACADEMY FORT BRAGG, North Carolina 28310-5000 LAST NAME FIRST NAME SSN M.I. / JR/II GENDER RANK PROMOTABLE? DOR ( DD MMM YY) PMOS HOME / CELL PHONE#: PROFILE: YES NO PRESENT UNIT ASSIGNED GT Score: (ex. 11B1P) TEMP, P2,P3, MEB CO/BTRY/TRP: (ex. HHC, A CO, 546 TH TRANS CO) BN/SQD: (ex. 1/504 TH, 50TH SIG BN, 159TH AVN BN) BCT/BDE/GRP: (ex. 4 BCT, 35 th TTSB, 3 rd GRP, 20th EN BDE) MAJOR COMMAND: SPONSOR: PLATOON SERGEANT: FIRST SERGEANT: 82D ABN DIV, USASOC, XVIII ABN, etc) (RANK & NAME/PH#) (RANK & NAME/PH#) (RANK, NAME/PH#, EMAIL) BRIGADE COMMAND SERGEANT MAJOR: EMAIL: (PH#) 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)
THE ARMY SCHOOL SYSTEM (TASS) UNIT PRE-EXECUTION CHECKLIST (FOR USE OF THIS FORM SEE TRADOC REG 350-18; PROPONENT IS TRADOC G-3/5/7, TOMA) Please print or type 1. NAME 2. UNIT: 3. COURSE TITLE: 4. REPORT DATE: Supervisor's Initials Soldier s initials PART 1 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 competion document) All rquired 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? Soldiers has Government Travel Card or adequate cash/traveler checks? Individual orders received (10 copies)? Soldier has current periodic health assessment? Soldier meets remaining Time in Service requirement? Ten (10) copies of orders? Transportation verified/dts approved? Soldier has current /valid identification card? Soldier has ID tags (1 pair)? Unit POC List: CDR Office: 1SG Office: FTM Office: Other: Other: Other: Unit Fax: 1SG Email: CSM Email: TRADOC Form 350-18-2-R-E, May 2016 PREVIOUS EDITIONS ARE OBSOLETE PAGE 1 OF 2
Minimum Aptitude Score (if applicable) PART II ROUTINE PREREQUISITES TASK REGULATION DATA SOLDIER DATA CL CO EL FA GM CL CO EL FA GM GT MM OF SC ST GT MM OF SC ST Color vision requirements (if applicable Physical demand rating/profile (PULHES) P U L H E S P U L H E S *See Part III for P/T profiles Military and civilian vehicle operator license(s) (if applicable): Military license number: Expiration date: Civilian license number: Expiration date: State: PART III- REQUIRED DOCUCMENTS Security clearance (if applicable, attach as required) * Permanent profile attendees (if applicable): Must have a signed copy of completed DA Form 3349 (must include Army Doctor-approved alternate aerobic event for APFT). All required waivers (if applicable) Other requirements of DA PAM 611-21 NOT PREVIOUSLY LISTED: Other requirements(if applicable) Hot weather injury YES or NO Cold weather injury YES or No 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 family that would Detract from or prevent my successful completion of course requirements. Student Signature: I have reviewed the above soldier s qualification and potential to successfully complete this Course, counseled them on these requirements, and herby verify their readiness to attend. Commanding Officer (typed name): Signature: TRADOC Form 350-18-2-R-E, May 2016 PREVIOUS EDITIONS ARE OBSOLETE Page 2 of 2
XVIII AIRBORNE CORPS AND FORT BRAGG NONCOMMISSIONED OFFICER ACADEMY Mandatory clothing and equipment requirement for ALL personnel attending the Basic Leader Course. *The NCO Academy does not issue any items of TA-50, clothing, or personal items.* Rank Last Name First Name Unit DAILY UNIFORM ITEMS (ALL SOLDIERS) Notebook 1 EA. C IPFU Complete IAW DA PAM 670-1 CH 12 1 EA. C CD-RW discs 2 EA. C - Trunks, Running Black 1 EA. C Wristwatch 1 EA. C - T-Shirt, Gray, Short Sleeve 1 EA. C Ink Pens (Black) 2 EA. C - T-Shirt, Gray, Long Sleeve (OCT-APR) 1 EA. C Belt, Trousers, ACU (TAN) 1 EA. C - Jacket, Running, Gray & Black (OCT-APR) 1 EA. C Boots (Tan) 1 PR. C - Pants, Running, Black (OCT-APR) 1 EA. C Patrol Cap, ACU, w/name tape/rank 1 EA. C - Cap, Fleece, Foliage Green 1 EA. C Coat, ACU 1 EA. C OR Trouser, ACU 1 EA. C APFU Complete IAW DA PAM 670-1 CH 12 Sec. II 1 EA. C Undershirt, Tan 1 EA. C - Trunks, Running Black w/ Army in Gold 1 EA. C Socks, Cushioned (Tan, Green, or Black) 1 PR. C - T-Shirt, Black, Short Sleeve 1 EA. C Identification Tags ( w/long & short chain) 1 SET C - T-Shirt, Black, Long Sleeve (OCT-APR) 1 EA. C Super Fine Tip Black Permanent Map Marker 2 EA. C - Jacket, Running, Black w/gold (OCT-APR) 1 EA. C camoflauge face paint 1 EA. C - Pants, Running w/ Army in Gold (OCT-AP 1 EA. C - Cap, Fleece, Black 1 EA. C Gloves (OCT-APR) 1 PR. C Running Shoes (Note 4) 1 PR. C Socks, White 1 PR. C Belt, Reflective (Note 6) 1 EA. C ITEMS NEEDED FOR THE SITUATIONAL TRAINING EXERCISE (ALL SOLDIERS) Rucksack / MOLLE 1 EA. C Parka, Wet Weather w/rank 1 EA. C Fighting Load Carrier 1 EA. C Trousers, Wet Weather 1 EA. C Ammo Pouches (To hold (6) Magazines) Protective Eyewear (Note 11) 1 PR. C Canteen, 1 Quart 2 EA. C Earplugs 1 PR. C Canteen, Cover, 1 Quart 2 EA. C Gloves (Note 11) 1 PR. C Hydration Bladder or 2 Quart Canteen w/cover & Carrying Strap (Note 8) 1 EA. C Flashlight w/colored Lenses & Batteries 1 EA. C Entrenching Tool 1 EA. C Assault Pack 1 EA. C Carrying Case, Entrenching Tool 1 EA. C Mattress, Pneumatic or Poly Pad 1 EA. C Improved First Aid Kit (IFAK) 1 EA. C Sleep System Complete Rifle, M16A1/A2 or M4 (Note 9) 1 EA. C - Sleeping Bag, Green 1 EA. C Blank Adaptor (M16 or M4) 1 EA. C - Sleeping Bag, Black 1 EA. C Magazines, 30 Round 7 EA. C - Bivy Cover 1 EA. C Weapon Cleaning Kit w/oil 1 EA. C - Stuff Sack 1 EA. C Helmet, ACH w/cover and band 1 EA. C Bag, Waterproof 1 EA. C Poncho, Nylon 1 EA. C Chem-lites, Yellow, 12 Hour 2 EA. C Liner, Poncho 1 EA. C IR Flag 1 EA. C Case, Compass, Lensatic 2 EA. C MRE 10 EA.C Compass, Lensatic 2 EA. C Whistle 1 EA. C Protractor (GTA 5-2-12) 2 EA. C Insect Repellent 1 EA. C #2 and Mechanical 0.5mm Pencils, 2 EA. C Sunscreen 1 EA. C 21 January 2015 1
PACKING LIST CONT. ADDITIONAL COLD WEATHER ITEMS FOR USE DURING (OCT APR) ALL SOLDIERS Undershirt, CW Lightweight or Midweight 2 EA. C Wind Jacket 1 EA. C Underwear, CW Lightweight or Midweigh 2 EA. C Soft Shell Jacket and Trousers 1 EA. C Gloves, Cold Weather w/inserts 1 PR. C Boots, Cold Weather (Note 4) 1 PR. C Fleece Jacket 1 EA. C Fleece Cap, Foliage Green (For Wear w/acus) 1 EA. C TDY SOLDIERS ONLY Bag, Barracks 1 EA. C Towel, Washcloth (Brown) 2 EA. C Bag, Duffel 1 EA. C Towel, Bath (Brown) 4 EA. C Beret (Black or Maroon) 1 EA. C Brassieres (White / Neutral) 3 EA. F Socks, Cushioned (Tan, Green, or Black) 7 PR. C Underwear (White / Neutral) 7 PR. F Socks, Crew (White) 5 PR. C Drawers, Cotton 7 PR. M Glove, Light Duty Utility, Green (LDUG) 1 PR. C Toothbrush & Tooth Paste 1 EA. C Gloves, Inserts 2 PR. C Razor w/blades 1 EA. C Shave Cream / Powder 1 EA. C Laundry Detergent 1 EA. C Soap & Soap Dish 1 EA. C Wire Hangers 5 EA. C Deodorant 1 EA. C Belt, Trousers, ACU (TAN) 2 EA. C Lock (Combination Only) 3 EA. C Boots (Tan) 2 PR. C Suede Boot Cleaner 1 EA. C Patrol Cap, ACU, w/name tape/rank 1 EA. C Brush, Suede Boot 1 EA. C Coat, ACU 4 EA. C Shower Shoes (Black Only) 1 PR. C Trouser, ACU 4 EA. C Undershirt, Tan 6 EA. C M = MALE F = FEMALE C = COMMON ITEMS READ ALL NOTES ON PAGE 3 21 January 2015 2
Note 1: The listed items of clothing / equipment are the MINIMUM required while attending BLC. All uniforms / Equipment must be clean and serviceable. students must have all patches, name tapes and rank required for uniforms. Note 2: Students must have this document with all signatures, a current ID card with working PIN, Pre-execution checklist,1610, and a copy of any profile if applicable during class enrollment. Note 3: Students who wear prescription eyeglasses must have two pair of military issue eyewear, or military frame of choice to attend BLC. This is the only eyewear authorized for BLC. Note 4: Optional purchase boots IAW AR 670-1 are authorized. Cold weather boots are only authorized from OCT APR. No court, tennis, or basketball shoes are authorized for use with the IPFU or APFU, Only Running Shoes. Note 5: Students with allergies must bring their own medication and/or sting kit. Note 6: The only authorized PT belt is the yellow reflective belt. Note 7: Unit PT shirts are only authorized for wear during the Commandant s Run at the end of the cycle. Note 8: Hydration systems must be Coyote or UCP. No assault packs type system. Note 9: Weapons will not be outfitted with an M203, Tactical Lights, or any other additional optic device. (Iron Sights Only) Note 10: Students will be required to teach a class. Students will be responsible for providing all necessary / required supplies and equipment. For example: butcher paper, handouts, and training aids. Note 11: Effective immediately, all students attending BLC will have Army approved protective eyewear and gloves (See attached memo). Students are also authorized to wear Army issued knee and elbow pads during the STX. Note 12: Students must have serviceable ACU s. FR-ACU is authorized but cannot be mixed with ACU, and is not authorized for wear during the graduation ceremony. Student Signature First Line Supervisor 21 January 2015 3