Date:
Ext:
Please complete form fully where applicable.
less than 2 yrs
2 to 4 yrs
4 to 6 yrs
6 to 8 yrs
8 to 10 yrs
10 to 15yrs
15 to 20yrs
more than 20 yrs
less than 2 yrs
2 to 4 yrs
4 to 6 yrs
6 to 8 yrs
8 to 10 yrs
more than 10 yrs
7th Operations Support
436th Training
28th Bomb
9th Bomb
7th Civil Engineering
7th Contracting
7th Communications
7th Logistics Readiness
7th Mission Support
7th Security Forces
7th Services
7th Aircraft Maintenance
7th Component Maintenance
7th Equipment Maintenance
7th Maintenance Operations
7th Munitions
7th Medical Support
7th Aeromedical/Dental
7th Medical Operations
39th Airlift
40th Airlift
317th Maintenance
317th Aircraft Maintenance
317th Maintenance Operations
317th Operations Support
Other
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
not applicable
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
Why do you believe the Dyess We Care Team should select thedeployed member you are submitting for a room renovation?No more than 15 lines.
Explain why? No more than 15 lines.
If selected, what room would you like to see renovated for thedeployed member?
Describe recipient's interests. Include category information.(i.e., sports, hobbies, goals, etc.) No more than 15 lines.
Estimated return date:
Own
Rent
Does recipient own or rent?
Recipient's home address:
M
F
Sex:
-
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
>18
Age:
Child 6:
M
F
Sex:
-
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
>18
Age:
Child 5:
Please include age & gender of children:
0
1
2
3
4
5
6
>6
Yes
No
Married
Single
Single Parent
Widow/Widower
Divorced
Supervisor
Spouse
Child
Co-Worker
Friend
Other
M
F
Sex:
-
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
>18
Age:
Child 4:
M
F
Sex:
-
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
>18
Age:
Child 3:
M
F
Sex:
-
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
>18
Age:
Child 2:
Sex:
Age:
Child 1:
If yes, how many?
Does recipient have children?
Marital status:
Time in service:
Time stationed at Dyess AFB TX:
Squadron:
Rank:
Deployed individual's name:
Recipient Information
Your name:
Rank, if applicable:
Organization, if applicable:
Work phone:
Home phone:
Cell phone:
Relationship to deployed member:
Requester Information
-
<1
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
>18
M
F
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Please check entries before submitting.
Spouse's Name, if applicable:
Printable mail-in form