REQUEST FOR AND APPROVAL OF PERSONNEL ACTIONS

I. PERSONAL DATA
Last Name First Name Middle Initial

CAPSN

Grade

Charter Number

NY117
Duty Assignment

Wing

NY	Unit Name

Col. Francis S. Gabreski Squadron
II. DUTY ASSIGNMENT/STATUS CHANGE (CAPR 35-1)
FROM:	TO

(Duty Title/Status)	(Duty Title/Status)
III. AWARD OF AERONAUTICAL RATING/MISSION QUALIFICATIONS (CAPR 60-1)
AWARD AERONAUTICAL RATING/MISSION QUALIFICATION CHECKED BELOW:

Glider Pilot	Comd Pilot	Balloonist	Mission Observer	Ground Team Badge

Solo Pilot	Observer	Cdt Orient Pilot	CN Observer

Pilot	Master Observer	SAR Pilot	Transport Msn Pilot

Senior Pilot	Senior Observer	CD Pilot	Mission Scanner

Mission Pilot Qual Date	Mission Observer Qual Date

FAA License Number	FAA Physical Dated

FAA Rating	No. Hrs Logged as Pilot	Observer

CAP Form 5 Flight Check	CAP Form 91 Flight Check
IV. AWARD OF ACTIVITY AND SERVICE RIBBONS (CAPR 39-3)
AWARD ACTIVITY AND SERVICE RIBBON CHECKED BELOW:	AWARD OF CLASP (For additional award)

Command Service Ribbon	National Cadet Competition Ribbon	Cadet Orientation Pilot Ribbon

Red Service Ribbon	National Color Guard Ribbon	Counter drug Ribbon

"Find" Ribbon	Cadet Advisory Council Ribbon	Encampment Ribbon

Air Search and Rescue Ribbon	Cadet Community Service Ribbon	Recruiter Ribbon

Disaster Relief Ribbon	Cadet Special Activities Ribbon	A. Scott Crossfield Award

IACE Ribbon	Other (Specify)
V. TRANSFER (CAPM 39-2)
FROM:	TO

(Charter Number)	(Charter Number)

NOTE: The gaining unit commander should initiate the transfer form. The losing unit commander has 60 days after the transfer action appears on the Monthly Membership Listing to notify HQ CAP/DP if he/she disapproves of the transfer for any reason. In such cases, the transfer will be voided and the member returned to the losing unit.
VI. RETIREMENT (CAPR 39-1)
The above named individual is eligible for retirement from Civil Air Patrol in accordance with CAPR 35-1. His/her period of CAP service is indicated below (if this period of service is not continuous, please explain in the remarks section.

FROM:	TO

(Date)	(Date)
VII. REMARKS (use reverse side of form if additional space is required.)
I certify that all pertinent directives have been complied with and that this action is in the best interest of Civil Air Patrol.
Unit Charter No.

NY117	Signature of Requester	Typed Name and Grade of Requester

APPROVED	Signature of Flight/Squadron Commander	Flight/Squadron

NY117	Date

APPROVED	Signature of Group Commander	Group

Date

APPROVED	Signature of Wing Commander	Wing

Date

APPROVED	Signature of Region Commander	Region

Date

CAP FORM 2a, July 1998	Previous editions can be used.

VII. REMARKS (cont’d)

CAP FORM 2a, July 1998 REVERSE

Transfer of Property Responsibility

"We the undersigned officers of the Civil Air Patrol jointly certify that to the best of our knowledge and belief, all CAP property in the possession of ________ (Unit Number) is properly accounted for in accordance with CAPR 67-1 and applicable supplements thereto."

______________________________	_____________________________

Signature, Grade and Date	Signature, Grade and Date

_______________________________	_____________________________

Print Name	Print Name

Outgoing Supply Officer	Incoming Supply Officer

REQUEST AND APPROVAL OF PERSONNEL ACTIONS

Charles Kowalewski, D.O.

2004-09-09

PRIMARY

J. Sanderson

Civil AIr Patrol, Inc.