NCOA Policy Letters - Soldier Support Institute - U.S. Army

NONCOMMISSIONED OFFICER ACADEMYTest Administration StatementSTUDENT NAME ________________________ RANK ____ CLASS NUMBER _________(Last, First, MI)SUBJECT: Preparation for Taking (COURSE TITLE) Examination Date_________ IAW AR611-5, Page 3-2, Fig 3-1 (DA Form 5160-R, Test Administration Statement)I understand that I am not required to take the below named test, thisdate, provided there are extenuating circumstances such asfatigue, illness, emotional distress, family or financial problems etc.,which may interfere with my performance in this test; and that thetest will be administered at another time acceptable to me, the TCOconcerned, and the Commandant.INITIALS1. I ________________________ (am/am not) prepared to ConductSmall Group Instruction. If I am not prepared, I will attach awritten statement to this memorandum.2. I ________________________ (am/am not) prepared to ConductPlatoon Level Drill and Ceremony. If I am not prepared, I will attacha written statement to this memorandum.3. I ________________________ (am/am not) prepared to ConductPlatoon Level Inspection. If I am not prepared, I will attacha written statement to this memorandum.4. I ________________________ (am/am not) prepared to ConductPlatoon Level Physical Fitness Training. If I am not prepared, Iwill attach a written statement to this memorandum.5. I ________________________ (am/am not) prepared to SupervisePMCS. If I am not prepared, I will attach a written statementto this memorandum.6. I ________________________ (am/am not) prepared to Conduct anAfter Action Review. If I am not prepared, I will attach a writtenstatement to this memorandum.______________________________________________________Test Administration Statement Continued: