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Consult the memo on CHIT USAGE AND PROCEDURE for instructions on how to submit a chit. Remember to use black ink and all capital letters. Only fill out the necessary sections (emphasized, and marked with an *). Fill out the other items only if your advisor instructs you to do so.
| NAME*: | LAST, FIRST MI. [e.g.]STEVERSON, STEVE E. |
| RATE*: | Rank [e.g.]MIDN 1/C |
| SSN*: | [e.g.]123-45-6789 |
| SHIP OR STATION*: | NROTCU UC BERKELEY |
| DATE OF REQUEST*: | The date you submit the chit DD MMM YY [e.g.]12 JAN 02 |
| DEPARTMENT/DIVISION/WARD*: | Platoon and squad or "STAFF" [e.g.]1ST PLT, 2ND SQD |
| DUTY SECTION/GROUP*: | Your title [e.g.]SQD MBR, SDR LDR, PLT SGT, ETC. |
| NATURE OF REQUEST*: | In most cases, check "OTHER" and fill out the "REASON FOR REQUEST" section |
| NO. DAYS REQUEST: | SKIP (unless instructed to fill out) |
| FROM (DATE AND TIME): | SKIP (unless instructed to fill out) |
| TO (DATE AND TIME): | SKIP (unless instructed to fill out) |
| DISTANCE (MILES): | SKIP (unless instructed to fill out) |
| MODE OF TRAVEL: | SKIP (unless instructed to fill out) |
| LEAVE ADDRESS: | SKIP (unless instructed to fill out) |
| TELEPHONE NUMBER: | SKIP (unless instructed to fill out) |
| REASON FOR REQUEST*: | Fill out in the space provided. Begin with "RESPECTFULLY REQUEST." Specify all
dates, times, etc. Attach extra pages and/or documents if necessary (staple in upper left
corner behind chits). Include the name of your class advisor in parentheses at the end of
your statement. [e.g.]RESPECTFULLY REQUEST PERMISSION TO... (PURDY) |
| SIGNATURE OF APPLICANT*: | Sign your name with your first two initials and full last name. |
