SOU & PRI

Service Delivery Statement of Understanding (SOU) & Personal Readiness Inventory

The information herein is FOR OFFICIAL USE ONLY (FOUO) information which must be protected under the Freedom of Information Act (5 U.S.C. 552) and/or the Privacy Act of 1974 (5 U.S.C. 552a). Unauthorized disclosure or misuse of this PERSONAL INFORMATION may result in disciplinary action, criminal and/or civil penalties. *

I acknowledge that the below information will be used FOUO.

Name *

First

Last

DOD ID *

Command/Unit *

Rank *

(Ex: E-4 or O-2)

Email *

Phone Number *

OVERALL ADJUSTMENT TO MILITARY LIFE (Understand & support the military lifestyle & mission requirements, etc…)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

RELOCATION/MOVING (Ability to move when required)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

ADJUSTMENT TO COMMUNITY (Ability to find on/off-base information, services, events & activities, etc…)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

DEPLOYMENT READINESS (Ability to support short-notice deployments, awareness of available support for loved ones, etc…)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

EMPLOYMENT (Job search techniques & skills, ability to secure suitable employment, etc…)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

FINANCIAL READINESS (Basic needs & financial obligations met, savings, investments & retirement, etc…)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

MILITARY/WORK ENVIRONMENT (Work environment/relationships OPSTEMPO/pace of work)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

PERSONAL RELATIONSHIPS (Family, Friends, & loved ones etc…)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

RETENTION (Intention to continue military career past current commitment)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

TRANSITION TO CIVILIAN LIFE (Prepared for separation/retirement, aware of benefits & entitlements, etc.)

Selected Value: 0

Please rate how well things are going, in the past week, by selecting a number from 0-10, with 10 as the best possible rating.

PRINCIPLE PURPOSES: To record services offered by Military & Family Readiness Center (M&FRC) staff requested by and provided to DoD members to identify areas of interest/need as a basis for determining an appropriate course of action. ROUTINE USES: Each customer who makes an appointment with an M&FRC staff member will be asked to sign an SOU which will be electronically stored and secured. The individual’s record will contain demographic information, a brief description of your visit(s) and a service plan of action when appropriate. Each customer record will be maintained for the sole purpose of assisting the customer. DISCLOSURE: Except where M&FRC personnel are required to disclose by operation of law, matters discussed during consultations will not be discussed with your supervisor or referral agent. As a matter of routine, referral agents are not notified. Proper authorities will be notified of situations which may directly impact personal health, safety, or mission accomplishment. Failure to keep a referred-scheduled appointment warrants referral contact that may lead to possible disciplinary action. RESPECT TO PRIVACY: You can expect the M&FRC staff to respect your right to privacy; however, you should know that M&FRC staff do not have privileged communication. CONSULTATION LIMITATIONS: During any consultation at the M&FRC, options will be provided. We can help prioritize concerns and needs and assist you in understanding what resources may enable you to cope with personal and work-related issues. The M&FRC also offers classes and workshops as well as other resources that may be helpful. If you have any questions or concerns regarding the Statement of Understanding, please contact Ms. Anna Flowers at 843-708-2165 or anna.flowers@us.af.mil. *

First

Middle

Last

Sign your FULL NAME (First, M.I., Last) as acknowledgement that you have read and agree to the above statement.

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