5. WEIGHT CONTROL/FITNESS LEVEL OR CONDITIONS THAT COULD AFFECT SOLDIER TRAINING. Beginning BCT Height _______ Weight
______ Beginning AIT Height _______ Weight ________ Dental category _______ Profile Data: Profile Type _______ Profile Limitations ________
Exp Date _______
2. EDUCATION STATUS: List highest educational level attained and date it was attained (high school graduation date ________, years of college
_______, vocational school ________). List vocational training, unique job experiences, and last three jobs.
1. FAMILY/FINANCIAL STATUS: List any information that would affect/distract Soldier from training success (e.g., financial issues ______, Exceptional
Family Member Program (EFMP) _______, sole provider for family ________, military affiliation ________, family tragedy within the past year _______).
AIT MODULE TEST SCORES: ______________ DATE ______________ DATE ______________ DATE
BCT/OSUT APFT #
CLS CERTIFICATION DATE: ____________
SIT-UPS G / NG
1 - 1 - 1
EVENT
PUSH-UPS
SIT-UPS
1 MI RUN G / NG 2 MI RUN
DATE
TOTAL
PUSH-UPS G / NG
TIME
ARMY PHYSICAL FITNESS TEST
Combat Familiarization Fire
dditional MOS-related certifications:
Qual Day 2Qual Day 1
BASIC RIFLE MARKSMANSHIP
EVENT
RAW SCORE
EVENT RAW
SCORE
PUSH-UPS
SIT-UPS
2 MI RUN
DATE
TOTAL
AIT/OSUT APFT #
INITIAL MILITARY TRAINING (IMT)
SOLDIER ASSESSMENT REPORT
(For use of this form see TRADOC Reg 350-6; the proponent agency is DCG-IMT)
AUTHORITY:
DATA REQUIRED BY THE PRIVACY ACT OF 1974
PRIVACY ACT NOTICE
Title 5, United States Code, Section 301, Departmental Regulations; Title 10, United States Code, Section 3013, Secretary of the Army.
PRINCIPAL PURPOSE:
To assist leaders in verifying enlistment eligibility and in identifying Soldier leadership and personal readiness issues having a
predictable, direct, and substantial impact on initial entry training.
ROUTINE USES:
In addition to those disclosures generally permitted under 5 U.S.C. 522a(b) of the Privacy Act, these records or information contained
DISCLOSURE:
Disclosure of this information is voluntary. Failure to provide the requested information will hinder processing of official training related
a. NAME
b. PMOSC
TRADOC Form 350-6-2-R-E, NOV 2010 8.5X11
RECEPTION DS: BCT DS:
IT PSG:
UNIT: UNIT: UNIT:
START DATE: START DATE: START DATE:
E-MAIL ADDRESS: E-MAIL ADDRESS: E-MAIL ADDRESS:
PHONE: PHONE: PHONE:
PART II - PERSONAL DATA
(Record pertinent administrative data on Soldier)
(Initiated by Reception, updated at BCT or OSUT and AIT)
therein may specifically be disclosed outside the DOD as routine use pursuant to 5 U.S.C. 552a(b)(3) and published at
http://privacy.defense.gov/notices/army/A0600-8-104b_AHRC.shtml.
PART 1 - ADMINISTRATIVE DATA
c. DATE (YYYYMMDD)
(Last, First, Middle Initial)
functions.
3. LEADERSHIP EXPERIENCE IN PRE-ACCESSION (AS DESCRIBED BY RECRUIT AND IN IMT). List any positions of leadership such as Squad
Leader, Platoon Guide, ROTC, Police Explorers, Boy Scouts/Girl Scouts, Prior Service, etc.
4. LANGUAGE SKILLS OR BARRIERS: Identify and explain any language skills or barriers, either oral or written.
