Attach 3 DD2088 Statement of Ecclesiastical Endorsement.pdf

DD FORM 2088, JAN 2019 Page of

PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in)

CUI (when filled in)

Controlled by: OUSD(P&R) CUI Category: PRVCY

LDC: FEDCON

POC: dodhra.mc-alex.dhra-hq.mbx.forms@mail.mil

STATEMENT OF ECCLESIASTICAL ENDORSEMENT

OMB No. 0704-0190 OMB approval expires 20240831

The public reporting burden for this collection of information, 0704-0190, is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ADDRESS. RETURN COMPLETED FORM TO CHIEF OF CHAPLAINS (ITEM 3).

PRIVACY ACT STATEMENT

Authority: 10 U.S.C. 136, 533(a)(1), 643, 827, 3353(a)(1), and 5600(a)(1); DoD Directive 1304.19; DoD Instruction 1304.28; and E.O. 9397, as amended (SSN).

Principle Purpose(s): To verify the professional and ecclesiastical qualifications of Religious Ministry Professionals for initial appointment or chaplains change of career status appointments as chaplains in the Military Services. This form is an essential element of a chaplain's professional qualifications and will become part of a chaplain's military personnel record.

Routine Use(s): See the individual military personnel file system of records notices, located at: Army (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570051/ a0600-8-104b-ahrc/); Navy (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570310/n01070-3/); Marine Corps (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570626/m01070-6/); Air Force (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569821/f036-af-pc-c/); and Coast Guard (http:// edocket.access.gpo.gov/2008/E8-29793.htm) Disclosure: Voluntary; however, failure to provide the requested information may significantly delay the processing of this endorsement.

1. ECCLESIASTICAL ENDORSING AGENT (Complete entire form)

a. AS THE ECCLESIASTICAL ENDORSING AGENT AUTHORIZED TO REPRESENT (Name of religious organization) (Item 4a)

, I HEREBY VERIFY THAT THE PERSON INDICATED IN PARAGRAPH

2, BELOW, IS CREDENTIALED AND QUALIFIED FOR AN APPOINTMENT WITHIN THE MILITARY CHAPLAINCY (as indicated in paragraph 2(j)(k)

IN ACCORDANCE WITH THE STANDARDS CONTAINED IN DODI 1304.28. (Date of agent authorization - YYYYMMDD:)

b. TYPED OR PRINTED NAME (Last, First, Middle Initial) c. E-MAIL ADDRESS

d. ADDRESS. (1) STREET (Include apartment or suite number) (2) CITY (3) STATE (4) ZIP CODE

e. TELEPHONE (Include Area Code)

f. FAX NUMBER (Include Area Code)

g. SIGNATURE h. DATE SIGNED (YYYYMMDD)

2. PROSPECT INFORMATION. a. IS THIS AN INITIAL ENDORSEMENT? (X one) u YES NO

b. TYPED OR PRINTED NAME (Last, First, Middle Initial) c. SOCIAL SECURITY NUMBER (Last 4) d. TELEPHONE (Include area code)

e. ADDRESS. (1) STREET (Include apartment or suite number) (2) CITY (3) STATE (4) ZIP CODE

f. E-MAIL ADDRESS g. DATE OF BIRTH

(YYYYMMDD)

h. NUMBER OF YEARS OF PROFESSIONAL MINISTRY

EXPERIENCE PROSPECT HAS COMPLETED

i. NUMBER OF MONTHS OF PRIOR ACTIVE MILITARY SERVICE PROSPECT HAS COMPLETED

(1) OFFICER (2) ENLISTED

j. SOURCE OF ORDINATION/PROFESSIONAL CREDENTIALS k. DATE OF ORDINATION/PROFESSIONAL

CREDENTIALS (YYYYMMDD)

l. APPLICATION IS FOR (X one)

(1) CHAPLAIN CANDIDATE (4) ACTIVE DUTY (Navy Only: X (a) or (b)) (5) WITHDRAWAL OF ENDORSEMENT

(2) RESERVE (a) Initial Active Duty - 3 Years

(3) NATIONAL GUARD (b) Extended Active Duty - Indefinite

3. TO

a. CHIEF OF CHAPLAINS (X appropriate block)

(1) ARMY (2) NAVY

(3) AIR FORCE

b. ADDRESS. (1) STREET (Include apartment or suite number)

(2) CITY (3) STATE (4) ZIP CODE

4. FROM

a. TYPED OR PRINTED NAME OF RELIGIOUS ORGANIZATION GRANTING

RELIGIOUS MINISTRY PROFESSIONAL ENDORSEMENT

b. DATE OF CURRENT INTERNAL REVENUE CODE (IRC) 501(c)(3)

EXEMPT STATUS (YYYYMMDD)

c. EMPLOYER IDENTIFICATION

NUMBER (IRC)

d. TELEPHONE (Include Area Code) e. FAX NUMBER (Include Area Code)

f. ADDRESS. (1) STREET (Include apartment or suite number) (2) CITY (3) STATE (4) ZIP CODE

g. E-MAIL ADDRESS h. WEB SITE

5. COMMENTS

file:///See http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570051/a0600-8-104b-ahrc/ http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570051/a0600-8-104b-ahrc/ http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570310/n01070-3/ http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570626/m01070-6/ http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570626/m01070-6/ http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569821/f036-af-pc-c/

DD FORM 2088, JAN 2019

Page of

PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in) Document classification when filled in is CUI CUI (when filled in) Document classification when filled in is CUI Controlled by: OUSD(P&R) CUI Category: PRVCY LDC: FEDCON POC: dodhra.mc-alex.dhra-hq.mbx.forms@mail.mil

DD FORM XXXX (BACK), 20YYMMDD DRAFT

Page of

PREVIOUS EDITION IS OBSOLETE.

CUI (when filled in) Document classification when filled in is CUI CUI (when filled in) Document classification when filled in is CUI

INSTRUCTIONS

PREVIOUS EDITION IS OBSOLETE.

DD FORM XXXX, 20YYMMDD DRAFT

Page of

STATEMENT OF ECCLESIASTICAL ENDORSEMENT

OMB No. 0704-0190 OMB approval expires 20240831 The public reporting burden for this collection of information, 0704-0190, is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services, at whs.mc-alex.esd.mbx.dd-dod-information-collections@mail.mil. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.

PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE ABOVE ADDRESS. RETURN COMPLETED FORM TO CHIEF OF CHAPLAINS (ITEM 3).

PRIVACY ACT STATEMENT

Authority: 10 U.S.C. 136, 533(a)(1), 643, 827, 3353(a)(1), and 5600(a)(1); DoD Directive 1304.19; DoD Instruction 1304.28; and E.O. 9397, as amended (SSN).

Principle Purpose(s): To verify the professional and ecclesiastical qualifications of Religious Ministry Professionals for initial appointment or chaplains change of career status appointments as chaplains in the Military Services. This form is an essential element of a chaplain's professional qualifications and will become part of a chaplain's military personnel record.

Routine Use(s): See the individual military personnel file system of records notices, located at: Army (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570051/a0600-8-104b-ahrc/); Navy (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570310/n01070-3/); Marine Corps (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/570626/m01070-6/); Air Force (http://dpcld.defense.gov/Privacy/SORNsIndex/DOD-wide-SORN-Article-View/Article/569821/f036-af-pc-c/); and Coast Guard (http://edocket.access.gpo.gov/2008/E8-29793.htm) Disclosure: Voluntary; however, failure to provide the requested information may significantly delay the processing of this endorsement.

1. ECCLESIASTICAL ENDORSING AGENT (Complete entire form)

a. AS THE ECCLESIASTICAL ENDORSING AGENT AUTHORIZED TO REPRESENT (Name of religious organization) (Item 4a)

, I HEREBY VERIFY THAT THE PERSON INDICATED IN PARAGRAPH

2, BELOW, IS CREDENTIALED AND QUALIFIED FOR AN APPOINTMENT WITHIN THE MILITARY CHAPLAINCY (as indicated in paragraph 2(j)(k) IN ACCORDANCE WITH THE STANDARDS CONTAINED IN DODI 1304.28. (Date of agent authorization - YYYYMMDD:)

2. PROSPECT INFORMATION. a. IS THIS AN INITIAL ENDORSEMENT? (X one) u

i. NUMBER OF MONTHS OF PRIOR ACTIVE MILITARY SERVICE PROSPECT HAS COMPLETED

k. DATE OF ORDINATION/PROFESSIONAL

l. APPLICATION IS FOR (X one)

3. TO

a. CHIEF OF CHAPLAINS (X appropriate block)

4. FROM

9.0.0.2.20120627.2.874785 DD Form 2088, "Statement of Ecclesiastical Endorsement"