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Army Chess Application

This document is an application form for the U.S. Army Chess Tournament. It collects an applicant's personal information like name, rank, and social security number. It also requests details about their chess experience and qualifications, including recent tournaments played and ratings. Completing and signing the form allows an applicant to enter the Army Chess Tournament if they meet eligibility requirements.

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26 views

Army Chess Application

This document is an application form for the U.S. Army Chess Tournament. It collects an applicant's personal information like name, rank, and social security number. It also requests details about their chess experience and qualifications, including recent tournaments played and ratings. Completing and signing the form allows an applicant to enter the Army Chess Tournament if they meet eligibility requirements.

Uploaded by

3187265
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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U.S.

DOD Form dod-da-4878-r


ARMY CHESS TOURNAMENT APPLICATION
For use of this form, see AR 215-1; the proponent agency is ACSIM.

AUTHORITY: 10 U.S. Code 3013.

PRINCIPAL PURPOSE: Identification of participants in the Army Chess Tournament.

ROUTINE USES: Used to accept entries in the Army Chess Tournament and monitor participation. Information
furnished may be disclosed to any DOD component or part thereof, and upon request, to other
Federal, State, or local Government agencies in the pursuit of their official duties. Also, it may be
disclosed to news media in announcing contest participation and results. Finally, it may be used for
other lawful purchases, including law enforcement and/or litigation. The Social Security Number is
used for identification of the individual and records.

DISCLOSURE: Disclosure is voluntary. If the requested information and SSN are not provided, the individual may be
precluded from participation in this Army Chess Tournament.

1. NAME (Last, First, MI) 2. RANK (By Name, i.e., Captain) 3. SSN

4. MILITARY ADDRESS (Organization, Unit, State, P.O., APO, and 5. MAJOR ARMY 6. DUTY TELEPHONE NO.
Zip Code) COMMAND (MACOM) (Autovon/Commercial)

7. RECORD OF SIGNIFICANT CHESS ACTIVITY DURING THE LAST TWO YEARS (Use separate sheet, if necessary)

DATE PLACE EVENT STANDING/PLACE


(a) (b) (c) (d)

8. U.S. CHESS FEDERATION MEMBERSHIP CARD IDENTIFICATION NUMBER AND STATE OF REGISTRATION

a. U.S. CHESS FEDERATION b. DATE OF RATING c. DATE AND LOCATION OF LAST U.S. CHESS FEDERATION
RATING TOURNAMENT

9. I DID 10. INSTALLATION IDENTIFICATION (If applicable)

DID NOT PARTICIPATE IN AN INSTALLATION


QUALIFYING TOURNAMENT.

11. I DID 12. MACOM IDENTIFICATION (If applicable)

DID NOT PARTICIPATE IN A MACOM QUALIFYING


TOURNAMENT.

13. CURRENT DUTY ASSIGNMENT (Clerk, Medic, etc.) 14. SIGNATURE 15. DATE

DA FORM 4878-R, AUG 90 DA FORM 4878, FEB 84 IS OBSOLETE USAPPC V1.00

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