PerFORM PRO ENCR 2.00Application for the Evaluation of Learning Experiences During Misaunders/whs/diorNov 86 edition, 12/6/9|.?/c{{This document contains the first three pages. Page 4 is in Landscape mode and is filed as DD295p4. ,APPDATE &. APPNAME2(. zz[APPNAME]SSN2lt). yv!yv[SSN]\\--XARMYt _o!!^o ee sooPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. W V XNAVYt ?w!">w 6p7p uu sOiNiPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XAIRFORCE x!"x ^e_e oxnx sW]V]Press the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XMARINES i!"i QQ OpNp sooPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XCOASTGD O]!$N] ll ii sggPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XGRADE6 u!!u ]] `` sglflPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XGRADE7 i!"i >|?| s]]Press the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. ?~>~ XGRADE8 p!"p II sxxPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. __ XGRADE9 m!"m jj sWpVpPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. w~w XGRADE10 R!"R uu sG~F~Press the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. '~&~ XGRADE11 w!"w nn TT s[[Press the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XGRADE12 ?_!$>_ ._/_  sWwVwPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XNONEt I!!I ww siiPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. 7j6j XFRESH ^!"^ F_G_ ~~ sxxPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XSOPHt ge!"fe xx yy sRRPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XJUNIOR w!"w ii kk s?p>pPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XSENIOR l!$l ^w_w ff sOlNlPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in.XASSOC 'x!!&x 6`7` sooPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. ww XBACHt j!$j s7x6xPress the space bar to enter an X in this box or tab to the next field. System will auto-tab if box is filled in. kk CATNOt . METHOD . LOCATION . COMPL13 . !COURSE !.  SPONSOR ".  COMPL14 #. ! TO2ult'. ll[TO1]ATTNlt *. EDOFFSIGN +. oo wmvmEnter name if desired.TO1ult . APPNAME . APPGRADE . SSNlt . Oo!No 6o7o OggEnter numbers of SSN only. System will add dashes and auto-tab to next field.wkvk--PREVSVCNOS . MAILADDR . APPDOB . g !f nn pp 7uuEnter date as YYMMDD (i.e., January 1, 1964 = 640101)HOMEADDR . EDINSTNAME . EDINSTADDR . APPSIGN $. GjFj  Enter name if desired.SIGNDATE %. OfNfkk g[f[ 7uuEnter date as YYMMDD (i.e., January 1, 1995 = 950101),Courier1Arial"Times New RomanTimes New RomanArial"Univers (WN)"CG Times (WN)Univers (W1)"CG Times (W1)Wa@ $GyFyxxgg/.G[F[(1)(2)(3)(4)(5)(6)(7)(8)(9)9:,H-0 ) 9KK,[H]m COURSE xx,:-0 ) ,[]lm} SPONSOR VV:j*- 0 ) [j*]lmH} COMPL14 gg!j*0 0a  }R}15. APPLICANT CERTIFICATION: I have read the Privacy Act Statement on Page 2.!00  APPSIGN vv a. SIGNATURE j* 0  SIGNDATE onb. DATE SIGNED !)@"00   }}DD Form 295, NOV 86 !j*@"    ttPage 3 of 4 Pages