Form DD Form 2088 DD Form 2088 Statement of Ecclesiastical Endorsement

OMB No. 0704-0190
OMB approval expires
XX-XX-XXXX

STATEMENT OF ECCLESIASTICAL ENDORSEMENT

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 [email protected]. 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. Sections 136, 533(a)(1), 643, 827, 3353(a)(1), and 5600(a)(1); DoD Directive 1304.19; DoD 1304.28; and E.O. 9397, as amended (SSN).
PRINCIPAL PURPOSE(S): The information collected on this form is used 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. Completed forms are covered by recruiting and official military personnel file SORNs
maintained by each of the Services.
ROUTINE USE(S): The DoD "Blanket Routine Uses" found at http://dpclo.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx apply to this collection.
DISCLOSURE: Voluntary. However, failure to provide the requested information may significantly delay the processing of this endorsement.

1. ECCLESIASTICAL ENDORSING AGENT (To be completed by Endorsing Agent)
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

e. TELEPHONE
(Include Area Code)

f. FAX NUMBER
(Include Area Code)

g. SIGNATURE

b. TYPED OR PRINTED NAME (Last, First, Middle Initial)

u

YES

NO

c. SOCIAL SECURITY NUMBER (Last 4) d. TELEPHONE (Include Area Code)

NEEDS DD67

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

E-MAIL ADDRESS

(4) ZIP CODE

h. DATE SIGNED (YYYYMMDD)

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

f.

(3) STATE

(2) CITY

(3) STATE

(4) ZIP CODE

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

k. DATE OF ORDINATION/PROFESSIONAL
CREDENTIALS (YYYYMMDD)

j. SOURCE OF ORDINATION/PROFESSIONAL CREDENTIALS

l. APPLICATION IS FOR (X one)
(1) CHAPLAIN CANDIDATE

(4) ACTIVE DUTY (Navy Only: X (a) or (b))

(2) RESERVE

(a) Initial Active Duty - 3 Years

(3) NATIONAL GUARD

(5) WITHDRAWAL OF ENDORSEMENT

(b) Extended Active Duty - Indefinite

3. TO

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

a. CHIEF OF CHAPLAINS (X appropriate block)
(1) ARMY

(2) NAVY

(2) CITY

(3) STATE

(4) ZIP CODE

(3) AIR FORCE

4. FROM (To be completed by Endorsing Agent)
b. DATE OF CURRENT INTERNAL
REVENUE CODE (IRC) 501(c)(3)
EXEMPT STATUS

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

g.

h. WEB SITE

a. TYPED OR PRINTED NAME OF RELIGIOUS ORGANIZATION GRANTING
RELIGIOUS MINISTRY PROFESSIONAL ENDORSEMENT

E-MAIL ADDRESS

(4) ZIP CODE

5. COMMENTS

DD FORM 2088, DEC 2014

PREVIOUS EDITION IS OBSOLETE.

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