To request or record personnel actions for or by Soldiers in accordance with DA PAM 600-8.
Leave - Excess/Advance/Outside CONUS
Change of Name/SSN/DOB
DATA REQUIRED BY THE PRIVACY ACT OF 1974
SECTION I - PERSONAL IDENTIFICATION
SECTION V - CERTIFICATION/APPROVAL/DISAPPROVAL
7. The above Soldier's duty status is changed from
SECTION III - REQUEST FOR PERSONNEL ACTION
IS APPROVEDRECOMMEND APPROVAL IS DISAPPROVEDRECOMMEND DISAPPROVAL
SUPERSEDES DA FORM 4187, JAN 2000
AND REPLACES DA FORM 4187-1-R, APR 1995
DA FORM 4187, MAY 2014
HAS BEEN VERIFIED
Title 10, USC, Section 3013, E.O. 9397 (SSN), as amended
The DoD Blanket Routine Uses that appear at the beginning of the Army's compilation of systems of records may
apply to this system.
5. GRADE OR RANK/PMOS/AOC 6. SOCIAL SECURITY NUMBER
Special Forces Training/Assignment
Retesting in Army Personnel Tests
Reassignment Married Army Couples
Officer Candidate School
Asgmt of Pers with Exceptional Family Members
ROTC or Reserve Component Duty
Volunteering For Oversea Service
Reassignment Extreme Family Problems
12. COMMANDER/AUTHORIZED REPRESENTATIVE 13. SIGNATURE
For use of this form, see PAM 600-8; the proponent agency is DCS, G-1.
11. I certify that the duty status change (Section II) or that the request for personnel action (Section III) contained herein -
SECTION II - DUTY STATUS CHANGE (AR 600-8-6)
SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet)
8. I request the following action: (Check as appropriate)
4. NAME (Last, First, MI)
2. TO (Include ZIP Code)
3. FROM (Include ZIP Code)
1. THRU (Include ZIP Code)
On-the-Job Training (Enl only)
Service School (Enl only)
Exchange Reassignment (Enl only)
9. SIGNATURE OF SOLDIER (When required) 10. DATE (YYYYMMDD)
14. DATE (YYYYMMDD)
Voluntary; however failure to provide Social Security Number may result in a delay or error in processing the
request for personnel action.
APD LC v1.03ES
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Commandant USAPPS (CEPP-S)
12630 FLW 28
Fort Leonard Wood, MO. 65473
US Army Human Resources Command
ATTN: TAPC EPR R
1600 Spearhead Division Avenue
Fort Knox, KY. 40122
1. Soldier has been interviewed IAW the Commander's Interview Checklist.
2. Soldier meets the Qualifications listed in DA Pam 611-21, Chapter 10, para 10-12P.
3. Soldier understands that if he/she is accepted for training but fails to successfully complete the course, the obligated term of
service must be complete and that he/she will be reassigned or reclassified according to the needs of the Army.
4. Soldier has never been indicted or summoned in court as a defendant in a criminal proceeding under either civil or military law
(Art. 32 UMCJ)
5. Soldier is applying for the next available class date. Soldier understands that class placement is based upon the needs of the U.S.
Army Prime Power School and may be changed without notice.
6. (SOLDIER CAREER COUNSELOR'S OR RETENTION NCO POC INFORMATION "NAME, PHONE NUMBER, EMAIL
7. (SOLDIER'S EMAIL ADDRESS AND UNIT PHONE NUMBER)
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