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Get DA 5897 1999-2024

CHILDREN S AGES 20b. AGE DA FORM 5897-R JUL 90 IS OBSOLETE 19c. SCHOOL OR LOCATION 20c. RELATIONSHIP USAPA V1. Family Member 15. EDUCATION Number of years degree s 16. CLIENT S AGE 17. DATE MARRIED 18. TIMES MARRIED 19a. NAME OF CHILDREN 20a. OTHER HOUSEHOLD MEMBERS DA FORM 5897 MAY 1999 19b. U.S. DOD Form dod-da-5897 1. CASE NUMBER ARMY COMMUNITY SERVICE ACS CLIENT CASE RECORD For use of this form see AR 608-1 the proponent agency is OACSIM PRIVACY ACT STATEMENT 5 USC Section 301 Departmental Regulations 10 USC Section 3013 Secretary of the Army Army Regulation 608-1 Army Community Service Center. AUTHORITY PRINCIPAL PURPOSE To provide appropriate background information needed for Army Community Service personnel to help individuals seeking assistance. ROUTINE USES DISCLOSURE None. Voluntary. However failure to provide the requested information may impede Army Community Service personnel from being able to assist individuals effectively. SECTION A - GENERAL INFORMATION 3. DATE OF INITIAL 4. DATE CASE CLOSED APPOINTMENT YYYYMMDD YYYYMMDD 2. NAME OF CLIENT Last first MI 6. TYPE OF CASE Check one COUPLE INDIVIDUAL 9. SEX MALE FEMALE FAMILY 7. STATUS OF CLIENT Check one ACTIVE RESERVE FAMILY MEMBER RETIRED CIVILIAN 5. TOTAL NUMBER OF SESSIONS 8. BRANCH OF SERVICE SECTION B - PERSONAL DATA MARITAL STATUS Check appropriate box MARRIED SINGLE DIVORCED SEPARATED 11. CLIENT S ADDRESS AND E-MAIL ADDRESS Street City State and ZIP Code WIDOW/WIDOWER SINGLE PARENT W/CUSTODY 12. EMPLOYER/ASSIGNMENT DUAL MILITARY CAREER UNKNOWN 13. HOME PHONE 14. WORK PHONE AND FAX PHONE a* Sponsor b. 00 21a* SPOUSE S NAME Last First MI SECTION C - SERVICE DATA 21b. MILITARY ADDRESS 22. SOURCE OF REFERRAL Check appropriate boxes SELF CIVILIAN AGENCY LEGAL COMMAND 21c* RANK/GRADE MEDICAL Military MILITARY CHAPLAIN VOLUNTEER 23. REQUEST FOR SERVICE PRESENTING PROBLEM 25. ASSESSMENT 26. TREATMENT PLAN 27. SUMMARY OF SERVICE PRIMARY SERVICE a* PERSONAL COUNSELING b. MARRIAGE COUNSELING c* FAMILY COUNSELING d. FAMILY/CHILD DEVELOPMENT e. EXCEPTIONAL FAMILIES f* CAREER INFORMATION g. FINANCIAL COUNSELING h. EMPLOYMENT COUNSELING i. RELOCATION COUNSELING k. SUPPLEMENTAL SERVICES Specify BOOKS/PAMPHLETS RECOMMENDED 29. REFERRALS TO c* RED CROSS d. HOUSING e. CHILD CARE CENTER f* MEDICAL g. VA h. SOCIAL SECURITY i. OTHER Specify 30. FAMILY ADVOCACY INFORMATION a* SPOUSE ABUSE b. CHILD ABUSE c* CHILD NEGLECT d. INCEST e. RAPE f* SEXUAL ASSAULT g. DRUG ABUSE h. ALCOHOL ABUSE CLASSES/WORKSHOPS RECOMMENDED 33. FOLLOWUP 34a* ACS STAFF MEMBER S SIGNATURE 34b. AUTHORITY PRINCIPAL PURPOSE To provide appropriate background information needed for Army Community Service personnel to help individuals seeking assistance. ROUTINE USES DISCLOSURE None. Voluntary. However failure to provide the requested information may impede Army Community Service personnel from being able to assist individuals effectively. ROUTINE USES DISCLOSURE None. Voluntary. However failure to provide the requested information may impede Army Community Service personnel from being able to assist individuals effectively. SECTION A - GENERAL INFORMATION 3. DATE OF INITIAL 4. DATE CASE CLOSED APPOINTMENT YYYYMMDD YYYYMMDD 2. .

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