REQUEST FOR SEPARATION ORDERS INFORMATION SHEET

This information is used to complete your separation orders and DD214. Correct, current information is critical. All fields that are applicable to separations (ETS, Chapters, Medicals or Officer Separations) are mandatory. Provide the best information possible, and please ensure the information is clear and legible. 

Packets can be emailed to: usarmy.stewart.id-readiness.mbx.dhr-transition-outprocessing@army.mil 
(subject line must read: ETS Packet & SM Full Name) 

TYPE OF SEPARATION (please check one) 

____ETS   _____ Chapter   ____ Medicals w/less than 30%   ______ Officer REFRAD 

PERSONAL INFORMATION: 
Name: _______________________________ SSN: _____________________ 

Rank: _______________ Unit/BDE: ______________________________________ 

army.mil email address: ___________________________________________ 

Civilian email address: _______________________________________________
Note: due to security protocols orders may not deliver to civilian emails 

Cell Phone #: ___________________________________________________________ 

Mailing Address after Separation: 
Number/Street: _________________________________________________________ 

City/State/ Zip: __________________________________________________________ 

DOCUMENTS REQUIRED: 
Enlisted Soldiers: 
•	Current STP (formerly ERB/SRB/ORB) 
•	DD FORM 4/1 & DD FORM 4/3 (located in iPERMS) 
•	All Reenlistment Contracts (if applicable) 
•	All DA 1695 (Oath of Extension of Enlistments, if applicable) 
•	All Prior DD214s (if applicable) 

Officers: 
•	Current STP (formerly ORB/SRB)
•	DA 71 (Oath of Office) 
•	Appointment Memo or Activation Orders (the orders bringing you on Active Duty) 
•	All Prior DD214s (if applicable) 
•	RPAS DA 5016, Chronological Statement of Retirement Points (if applicable)

ETS/Separation Date: ______________________________________
Projected Leave Date: ______________________________________

NOTE: Per AR-635-8 Separation orders are normally published 60-120 days prior to scheduled separation date; however, with an approved leave request orders can be published up to 180 days prior to separation.