Disclosure of information is mandatory. If required information is not provided removal from the
school could result or military student could be subject to a violation of Article 92 UCMJ.
Ended Begins
Signature of Student
Will End
Give reason for any absence which may affect your ability to keep up with your studies (Sickness, leave, or other emergencies)
Branch/MOSLast Name - First Name - Middle Initial Grade Social Security No.
Current Mailing Address (Include ZIP Code)
Name of School
(City & State)
Electronic Mail Address
Began
If you are having any difficulty with your academic work, give pertinent details
If any subjects have been dropped since last report, give reasons
Remarks (Enter any recommendations, observations, or requests you desire to make)
Date
QUARTER, SEMESTER OR TERM UPCOMING
Department and Major Field of Study
REPORT TO TRAINING AGENCY
For use of this form, see AR 621-1; the proponent agency is DCS, G-1.
Home Phone (Include Area
Code)
Army Program (Check one)
If any subjects outside of normal prescribed course have been added since last report, give complete information (If added course will necessitate a
change in present contract, clearance must be obtained from the training agency.)
NOTE:
DATA REQUIRED BY THE PRIVACY ACT OF 1974
Official Title of Degree Which You Expect to
Receive
Date
Expected
Type System (Check one)
QUARTER, SEMESTER OR TERM JUST COMPLETED
SUBJECTS STUDIED DURING ABOVE PERIOD SUBJECTS TO BE STUDIED
Course Title
Credit
Hours
DA FORM 2125, MAR 1999
EDITION OF OCT 1984 IS OBSOLETE.
APD LC v1.02ES
Course
No.
Course Title
Credit
Hours
Course
No.
GRADE
AUTHORITY:
PRINCIPAL PURPOSE:
ROUTINE USES:
DISCLOSURE:
Fully Funded
Degree
Completion
Scholarship
Semester Quarter Other
Section 301, Title 5, USC; and Section 3013, Title 10.
Cooperative
Degree
To provide a continuing contact with the military student while in attendance at a civilian school
under a military sponsored program.
Data collected is used to identify the school; to monitor the subject studies; to obtain student
response to selected question; to identify the Army program; to obtain course title /s/, credit hours
and grades; to obtain academic plan including faculty advisor awareness; and to establish an
address including home phone whereby the military student can be contacted since, normally, the
student will reside off-post.
The reverse side of this form will be completed by the student and faculty advisor initially upon entry into school and when changes to
academic programs are required.
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