NGB Form 901 ARNG HS Verification Form

ARMY NATIONAL GUARD
HIGH SCHOOL VERIFICATION FORM

OMB CONTROL NO: 0704-XXXX
EXP. DATE: XX/XX/XXXX

Section 1. General Information (to be completed by student)
Student Name (Last, First, Middle):
School Name:
School Mailing Address:

Section 2. Certification by School Official (to be completed by School Official)
Junior or Senior
Current Grade Level of Student: __________________
(Enter Student’s Name) will graduate ______________.
(MM/Year)
There is reasonable assurance that _________________
(MM/Day/Year)
The last scheduled day of school for the current school year is ________________.
(MM/Day/Year)
The first scheduled day of the next school year is______________.

School Official Name (Last, First, Middle):
Phone:

Title:

Email:

Signature:

Date (MM/Day/Year):

Section 3. Consent (To be completed by parent/guardian)

(Number of Days) days of school from
I hereby give permission for ___________________
(Enter Student’s Name) to miss ______________
either the current school year or the beginning of the next school year in order to meet the minimum (75
day) training requirement under the Split Training Option.
(Enter Student’s Name)
I authorize the school official(s) to release school transcripts for _________________.

Parent/Guardian Name:

Signature:

Date:

RETURN THIS FORM TO THE RECRUITER UPON COMPLETION OF SECTIONS 1-3

Section 4. Authorization (to be completed by Recruiter)
Recruiter/Representative Name:

Signature:

Date:

PAPERWORK REDUCTION ACT (PRA) BURDEN STATEMENT
The public reporting burden for this collection of information, 0704-XXXX, is estimated to average 5 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.
PRIVACY ACT STATEMENT
AUTHORITY: Title 10 USC Section 503, Enlistments: recruiting campaigns; compilation of directory information. PRINCIPAL PURPOSE(s): The purpose(s) for
which the information is to be used, is to verify applicant(s) who claim to be high school junior(s) or senior(s) and are in good standing to graduate. Used to
verify the mandatory date of return to school, and establishes the date the school will resume in the next school calendar year. ROUTINE USE(s): None
DISCLOSURE: Voluntary, however, failure to disclose the information may delay entry into the split training program.

NGB Form 901, 20181001