DD 0293
DD 0293
0704-0004
FROM THE ARMED FORCES OF THE UNITED STATES OMB approval expires
(Please read Privacy Act Statement and Instructions on Pages 3 and 4 BEFORE completing this application.) Dec 31, 2017
The public reporting burden for this collection of information, 0704-0004, is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering
and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including
suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, at [email protected]. Respondents should be aware that
notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
RETURN COMPLETED FORM TO THE APPROPRIATE ADDRESS ON BACK OF THIS PAGE.
1. APPLICANT DATA (The person whose discharge is to be reviewed). PLEASE PRINT OR TYPE INFORMATION.
a. BRANCH OF SERVICE (X one) ARMY MARINE CORPS NAVY AIR FORCE COAST GUARD
b. NAME (Last, First, Middle Initial) c. GRADE/RANK AT DISCHARGE d. SOCIAL SECURITY NUMBER
e. CURRENT MAILING ADDRESS OF APPLICANT OR PERSON NAMED IN ITEM 11 f. TELEPHONE NUMBER (Include Area Code)
(Forward notification of any change in address.)
g. E-MAIL
2. DATE OF DISCHARGE OR SEPARATION 4. DISCHARGE CHARACTERIZATION RECEIVED 5. BOARD ACTION REQUESTED (X all that apply)
(YYYYMMDD) (If date is more than 15 years (X one)
CHANGE TO HONORABLE
ago, submit a DD Form 149) HONORABLE
CHANGE TO GENERAL/UNDER HONORABLE
GENERAL/UNDER HONORABLE CONDITIONS CONDITIONS
3. UNIT AND LOCATION AT DISCHARGE UNDER OTHER THAN HONORABLE CONDITIONS CHANGE TO UNCHARACTERIZED (Not applicable
OR SEPARATION to Air Force or service members with over 6 months of
BAD CONDUCT (Special Court-Martial only) service)
UNCHARACTERIZED CHANGE NARRATIVE REASON FOR
SEPARATION:
OTHER (Explain)
6. ISSUES: WHY AN UPGRADE OR CHANGE IS REQUESTED AND JUSTIFICATION FOR THE REQUEST (Continue in Item 13. See instructions on Page 3.)
c. E-MAIL
11. APPLICANT MUST SIGN IN ITEM 12.a. BELOW. If the record in question is that of a deceased or incompetent person, LEGAL PROOF OF
DEATH OR INCOMPETENCY MUST ACCOMPANY THE APPLICATION. If the application is signed by other than the applicant, indicate the
name (print) and relationship by marking a box below.
SPOUSE WIDOW WIDOWER NEXT OF KIN LEGAL REPRESENTATIVE OTHER (Specify)
12. CERTIFICATION. I make the foregoing statements, as part of my claim, with full knowledge of the penalties CASE NUMBER
involved for willfully making a false statement or claim. (U.S. Code, Title 18, Sections 287 and 1001, provide (Do not write in this space.)
that an individual shall be fined under this title or imprisoned not more than 5 years, or both.)
a. SIGNATURE - REQUIRED (Applicant or person in Item 11 above) b. DATE SIGNED - REQUIRED (YYYYMMDD)
PRINCIPAL PURPOSE(S): To apply for a change in the characterization or reason for military discharge issued to an individual. The appropriate Military
Service Discharge Review Board reviews submitted packages and makes determinations. Completed forms are covered by the correction of discharge
review board and official military records SORNs maintained by each of the Military Services. The DoD Systems of Records Notices can be located at
http://dpcld.defense.gov/Privacy/SORNsIndex/DODComponentNotices.aspx.
ROUTINE USE(S): The DoD Blanket Routine Uses found at http://dpcld.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx may apply to this
collection.
DISCLOSURE: Voluntary. However, failure to provide identifying information may impede processing of this application. The SSN is used by the Military
Services to ensure the correct individual’s official military personnel file is updated.
Applicable SORNs:
Discharge Review Board Records:
Army (http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/6000/a0015-185-sfmr.aspx)
Navy/Marine Corps (http://dpcld.defense.gov/Privacy/SORNsIndex/DODwideSORNArticleView/tabid/6797/Article/6510/nm01000-1.aspx)
Air Force (http://dpcld.defense.gov/Privacy/SORNsIndex/tabid/5915/Article/5899/f036-safcb-a.aspx)
Coast Guard (http://www.gpo.gov/fdsys/pkg/FR-2011-10-28/html/2011-27881.htm)
Example: Issue 1. Brief, page 2, paragraph 1, sentences one and two. ITEM 10.a - d. Omit if you do not have a representative/counsel. If you
Applicants should be as specific as possible with all references so the later obtain the services of either, inform the Board immediately.
Board can clearly distinguish the scope of the issue. Because it is to
your benefit to bring such issues to the Board's attention as early as The military services do not provide counsel representation or
possible in the review, if you submit a brief, you are strongly urged to set evidence for you, nor do they pay the cost of such representation under
forth all such issues as a separate item at the beginning of the brief. any circumstance. The following organizations regularly furnish
representation at no charge to you. Representatives may or may not be
ITEM 8. Evidence not in your official records should be submitted to the lawyers.
Board before the review date. It is to your advantage to submit such 1. American Legion
documentation with this application. This also applies to legal briefs or 2. Disabled American Veterans
counsel submissions. However, you have the right to submit evidence 3. State or Regional Veterans Offices
until the time the Discharge Review Board closes the review process for
deliberation. Documents that are of the most benefit are those which In addition, there are other organizations willing to assist you in
substantiate or relate directly to your issues in Item 6. Other documents completing this application and to provide representation at no cost. It is
that may be helpful are character references, criminal, credit and to your advantage to coordinate with your counsel prior to submitting
employment reports, educational achievements, exemplary post-service this application. This will insure that your counsel is able to appear at
conduct, and medical reports. You should add your name and Social the location you listed in Item 9. Please note that some of the
Security Number to each document submitted. The Board will consider all organizations listed above only represent applicants who appear before
documents submitted in your behalf, but will respond in writing only to the Board in the Washington, D.C. Metro Area. Contact your local
those issues set forth in Item 6. veterans affairs office, Veterans Administration Office or veterans
service organization for further information.
ITEM 9. TYPE OF REVIEW REQUESTED
ITEM 11. If the former member is deceased or incompetent, the
A Discharge Review is conducted in two basic ways: (1) Records application may be submitted by the next of kin, a surviving spouse or a
Review or (2) Hearing. legal representative. Legal proof of death or incompetency and
satisfactory evidence of the relationship to the former member must
1. Records Review. You may have the Board conduct a discharge accompany this application.
review based solely on military records and any additional documentation
that you provide. This review is conducted without personal appearance ITEM 12.a. and b. A signature and date entered by the applicant or
by you and/or your counsel appearing. A personal appearance hearing person identified in Item 11 are required.
can be requested, however, you forfeit your right to a record review.