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Get DD Form 1172-2, Application For DoD Common Access Card - DEERS Enrollment, May 2004

AY GRADE Form Approved OMB No. 0704-0415 Expires Apr 30, 2007 APPLICATION FOR DEPARTMENT OF DEFENSE COMMON ACCESS CARD DEERS ENROLLMENT 7. GEN. CAT 2. SEX 8. CITIZENSHIP 9. DATE OF BIRTH (YYYYMMMDD) 13. CURRENT RESIDENCE ADDRESS 3. SSN 4. STATUS 5. ORGANIZATION 11. LAST UPDATE (YYYYMMMDD) 10. PLACE OF BIRTH 12. V/I 14. SUPPLEMENTAL ADDRESS INFORMATION 15. CITY 16. STATE 17. ZIP CODE 20. CITY OF DUTY LOCATION 21. STATE OF DUTY LOCATION 18. COUNTRY 19. OFFICE E-MAIL ADDRESS 2.

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