Spouse Leave Form

          1-8 CAV SPOUSE LEAVE INFORMATION

PRIVACY ACT STATEMENT

AUTHORITY:  5 U.S.C. 301, 10 U.S.C. Section 3013 and 4301, Secretary of the Army, Army Regulation 25-1, Army Information Management, Army Regulation 380-19, Information Systems, E.O. 9397 (SSN).  PRINCIPLE PURPOSE (S): To assist the Rear Detachment Commander/ NCOIC/ CFS/ FRG and Army Agencies  in their mission of providing care and assistance to families of Service members who are required to be away from their home station.  ROUTINE USES:  (1) To identify the families who will be out of the Ft. Hood area for a given time in order to have proper contact information.   MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION:  Voluntary information is required to assist the individual and his/her family members.  Failure to provide the required information could result in a delay in providing assistance/ information to the individual and/ or family members.  

This leave information sheet is strictly used as a means to quickly contact spouses in the event of an emergency; it is not used as a “tracking device.”

1.  Name_______________________________________________________________________

2.  Sponsor’s Rank and Name______________________________________________________

3.  Sponsor’s Company ___________________________________________________________

4.  Date(s) that you and your family will be gone_______________________________________

5.  Address that you will be at:_____________________________________________________

6.  Means of travel to destination:___________________________________________________

7.  Nearest military installation (if known):___________________________________________

8.  Phone number that you can be reached at:__________________________________________

9.  Secondary phone number:_______________________________________________________

10.  Email address:________________________________________________________________

11.  A Point of Contact’s name and telephone number where you’re located in case we cannot contact you: ____________________________________________________________________

**The above information is correct.  If I should deviate from my plans I will contact my FRG leader or Rear Detachment Command to update my contact information.

_____________________________________________                                        ______________

                     Signature                                                                                                        Date

Please return this form to Chelsea Watson, 1-8 CAV's FRSA, 254-553-0112