Date: ____________________

Name: ______________________________________________________________________________________________________

NIA #: __________________________________Roster #: ______________________________________________________

Unit: ________________________________________

Reason for Emergency Leave: ___________________________________________________________________________________

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

Destination: _________________________________________________________________________________________________

From: Date__________/Time__________ To: Date__________/Time__________

This individual is authorized emergency leave for ______ hours.

Approved/Disapproved

Company Commander: Signature:_______________________________________________ Date:_______________________

Battalion Commander: Signature:________________________________________________ Date:_______________________
____________________________________________________________________________________________________________

I understand the dates and time of my leave authorized.
I understand that I could be subject to recycle for missed training.
I understand that if I fail to report on time is grounds for recycle or dismissal.
I understand that all advance pay will be deducted from my pay.
I understand all the stated above, and will inform NIATC if any difficulties arise or report to the nearest Recruiting Station for assistance.

___________________________________________
Printed Name
___________________________________________
Signed

Requested Advance Pay in the amount of $________

CMATT APROVAL:

Approved Advance Pay in the amount of $________

NAME: ___________________________________

RANK: ___________________________________

SIGNATURE: _____________________________
CMATT


Coalition Military Assistance Training Team
Tadji, Iraq

EMERGENCY LEAVE FORM

NIA IDENTIFICATION CARD