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SSL Secured Application Choose your training Graphic Arts & Web Design Microsoft Office & Windows Vista Choose your computer Home-Study + Tech Pack SONY All In One PC Home-Study + Tech Pack 1 Gaming PC Home-Study + Tech Pack 2 Gaming PC Home-Study + Tech Pack 3 Gaming PC Home-Study + Tech Pack 4 Gaming PC Home-Study + Tech Pack 5 12.1" Netbook Home-Study + Tech Pack 6 14.1" Notebook Home-Study + Tech Pack 7 15.6" Notebook Home-Study + Tech Pack 8 17.3" Notebook Personal Information Name: (First, Last) Rank: Pv1 Pv2 PFC SPC CPL SGT SSG SFC MSG 1SG SGM Retired Status Active Duty Retired Military Military Spouse Your Date of Birth (dd / mm / yyyy) 12345678910111213141516171819202122232425262728293031 / JanFebMarAprMayJunJulAugSepOctNovDec / 1944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992 Your SSN (no dashes) Your home of record (Street/POB, City, State, ZIP) Date You Joined the Military (mm / yyyy) JanFebMarAprMayJunJulAugSepOctNovDec / 194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009 Date You Leave the Service (mm / yyyy) JanFebMarAprMayJunJulAugSepOctNovDec / 19441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068206920702071207220732074 PCS Date (mm / yyyy) JanFebMarAprMayJunJulAugSepOctNovDec / 200920102011201220132014201520162017 Your Present Military Unit Your Present Mailing Address (Street/POB, City, State, ZIP) Your Home Phone Your Work Phone Your Email Address Living Quarters What is the best number to reach you? Home Work What is the best time to call you? Morning Afternoon Evening Marital Status Single Married I was referred by Friend Ed Center Commander Web Search Flyer