***Unit***
Legal Action Request Form
Request for Administrative Separation, per AR 635-200, Chapter 14-12a, Minor
Disciplinary Infractions, be initiated against the below listed service member.
Rank/Grade: ___________ Name:___________________________________
Unit: ____________________________________________________________
Sex/ Race: ______________________ BASD: _________________________
Date Legal Action requested: ________________________________________
Date Legal Action complete: _________________________________________
________________________________________________________________
Characterization of Discharge requested: General/Other Than Honorable
Conditions
Specific factual reason Commander is requesting Administrative Separation:
________________________________________________________________
________________________________________________________________
________________________________________________________________
The following items are included in packet to begin initial processing:
__________ Final counseling recommending separation action.
__________ All other relevant Counseling/Supporting documents
__________ Article 15's
__________ Initial/Final flag - DA Form 268
__________ Service member's ERB
__________ Mental Health Evaluation and Physical required
_______________________________________
UNIT COMMANDER'S SIGNATURE
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