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Get USAR 107-R 2010

PRINTED NAME SOLDIER SIGNATURE FAMILY MEMBER DATE USAR Form 107-R 15 May 10 Previous edition is obsolete and will not be used. Page 1 of 2 SOLDIER S LAST NAME SECTION IV - SECONDARY POINT OF CONTACT SECTION V - CHILD INFORMATION CHILDREN Yes No GUARDIAN E-MAIL PHONE Gender Last Name First Name MI Mailing Address If different from family address SECTION VI - FAMILY CONCERNS SPECIAL NEEDS OR FAMILY CONCERNS DUAL MILITARY If Yes please explain SOLDIER S SSN DATE ENTERED IN PORTAL. Family Information Data Worksheet For use of this form see USAR Reg 608-1 the proponent agency is the USAR Family Programs Directorate. The information on this worksheet is for official use only within Army Reserve Family Programs and will not be furnished to any commercial enterprise company representative organization or agency outside the Department of Defense as established by the Privacy Act of 1974 5 USC 552A and AR 340-21. PRIVACY ACT ADVISORY STATEMENT AUTHORITY Title 10 U*S* Code Sections 3012 and 3013. PRINCIPAL PURPOSE To gather data that will assist in the development of appropriate Family Programs activities and services to servicemembers families identify individuals eligible to participate in the Family Programs and receive information* ROUTINE USES Information provided specifically name address and telephone number may be listed and distributed to other participants to enable development of a communication and support network. EFFECT OF WITHHOLDING CONSENT Voluntary disclosure. Failure to provide information may prevent the Family Programs participants from contacting you especially during periods of military separation or being able to provide you updated information on military unit related family activities programs and services available. SECTION I - SOLDIER INFORMATION LAST NAME RANK FIRST NAME DOB MI MOB DATE MM/DD/YYYY TOUR LENGTH of DAYS MAILING ADDRESS STREET APT. CITY STATE PRIMARY PHONE COUNTRY SECONDARY PHONE PRIMARY E-MAIL ZIP CODE SECONDARY E-MAIL PRIMARY UNIT MAJOR COMMAND REASSIGNED UNIT MARITAL STATUS Single Married Divorced SECTION II - PRIMARY POINT OF CONTACT RELATIONSHIP TO SOLDIER PRIMARY LANGUAGE SECTION III - CONSENT Your Primary Point of Contact will be contacted by the Family Programs Office staff* Please initial to release this information to FRG volunteers. Family Information Data Worksheet For use of this form see USAR Reg 608-1 the proponent agency is the USAR Family Programs Directorate. The information on this worksheet is for official use only within Army Reserve Family Programs and will not be furnished to any commercial enterprise company representative organization or agency outside the Department of Defense as established by the Privacy Act of 1974 5 USC 552A and AR 340-21. The information on this worksheet is for official use only within Army Reserve Family Programs and will not be furnished to any commercial enterprise company representative organization or agency outside the Department of Defense as established by the Privacy Act of 1974 5 USC 552A and AR 340-21. PRIVACY ACT ADVISORY STATEMENT AUTHORITY Title 10 U*S* Code Sections 3012 and 3013. PRINCIPAL PURPOSE To gather data that will assist in the development of appropriate Family Programs activities and services to servicemembers families identify individuals eligible to participate in the Family Programs and receive information* ROUTINE USES Information provided specifically name address and telephone number may be listed and distributed to other participants to enable development of a communication and support network. .

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