subject_line
Defense Counsel Services
Soldier Information:
Name, Status and Unit of Assignment
Last Name:
First Name:
Middle Initial:
Rank:
-SELECT-
E-1|PVT
E-2|PV2
E-3|PV3
E-4|SPC
E-5|SGT
E-6|SSG
E-7|SFC
E-8|MSG
E-8|1SG
E-9|SGM
E-9|CSM
W-1|W01
W-2|CW2
W-3|CW3
W-4|CW4
W-5|CW5
O-1|2LT
O-2|1LT
O-3|CPT
O-4|MAJ
O-5|LTC
O-6|COL
O-7|BG
O-8|MG
O-9|LTG
O-10|GEN
Home Address:
City:
State:
AZ
CA
GU
HI
NV
Zip Code:
Work Phone:
Home Phone:
AKO Email Address:
Civilian Email Address:
Indicate Your Current Status:
-SELECT-
MDay
SAD
AGR
ADSW
TECH
NG Membership:
AZ
CA
GU
HI
NV
Gender:
Male
Female
Date you enlisted into National Guard:
Years of Creditable Service:
Highest NCOES/PME Level Completed:
Deployments (ex: Iraq, AUG 2009 – JUN 2010):
Awards:
Civilian Occupation:
College (attended/ing or planning):
Using Military Benefits?
Yes
No
Primary MOS & Alternate MOS:
ETS:
+
Unit Information:
Unit Name
Unit Address:
City
State:
CA
NV
GU
HI
Zip Code:
Unit POC Rank:
-SELECT-
E-1|PVT
E-2|PV2
E-3|PV3
E-4|SPC
E-5|SGT
E-6|SSG
E-7|SFC
E-8|MSG
E-8|1SG
E-9|SGM
E-9|CSM
W-1|W01
W-2|CW2
W-3|CW3
W-4|CW4
W-5|CW5
O-1|2LT
O-2|1LT
O-3|CPT
O-4|MAJ
O-5|LTC
O-6|COL
O-7|BG
O-8|MG
O-9|LTG
O-10|GEN
Unit POC Work Phone:
Unit POC Cell Phone:
Unit POC AKO Email Address:
Offense Description:
Select type and nature of case:
-SELECT-
(P1) General Court-Martial (GCM)
(P1) Special Court-Martial (SPCM)
(P1) Article 32
(P2) Article 15
(P2) Summary Court-Martial (SCM)
(P2) Positive Urinalysis
(P2) Involutary Enlisted Seperation
(P2) Involutary Officer Seperation
(P2) Reduction Board
(P2) AGR Separation
(P3) AR 15-6 Investigation
(P3) CID Investigation
(P3) Commander's Inquiry
(P3) IG Investigation
(P3) Letter of Reprimand
(P3) Consultation
(P3) Other
Indicate what counsel is needed for:
Consultation
Representation
Enter the date of the alleged offense:
+
Enter the alleged offense:
Other Soldiers/Civilians involved:
Enter the date of notification to the Soldier:
+
Suspense Date:
+
Date of the Board (if scheduled):
+
Unit POC Name (Full time):
Enter location of board (if scheduled):
Have you spoken to a Judge Advocate or other Attorney on this issue or one connected to it?:
Yes
No
Do you currently have an Attorney or Judge Advocate assigned to handle this matter?:
Yes
No
Prior Legal Issues (yes/no dropbox):
Yes
No
If yes, list each matter and if represented the name of the attorney and contact info: