HELICOPTER SUPPORT REQUEST

1. Travel Statement: (Select IAW AR 95-1, see page two)

a. SELECT (1-4) 1 - Required Use 3 - Special Mission Use
2 - Operational Use 4 - Other Official Travel
2. Unit /Section to be supported:
3. Purpose/Details of Mission:

Estimated Estemated
L Date Departure Location: Destination Location:
Time Time of
E of Airport, Heliport, FBO, LAT/LON, Airport, Heliport, FBO, LAT/LON,
Depart: Arrival:
G Flight MGRS, PZ MGRS, LZ
(Local) (Local)
1
2
3
4
5
6
Remarks: (Special Mission Requirements, etc.)

Cargo Type (Dimensions, weight, etc.)

4. Passenger Manifest: (Attach additional manifest if needed)

SVC Codes: R=ARMY, A=Air Force, C=Coast Guard, M=Marine, V=Navy, F=Foreign Civilian or Military (denote VIPs with **)
SVC GRADE NAME: (Last, First MI) UIC SSN (Last 4) Pass WT Bag WT
1 0
2 0
3 0
4 0
5 0
6 0
7 0
8 0
9 0
10 0
11 0
12 0
13 0
14 0
15 0
16 0
17 0
18 0
TOTALS: 0 0

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 HELICOPTER SUPPORT REQUEST (Page 2)
5. Requestor
a. NAME (Last, First Middle Initial) b. GRADE c. DUTY TITLE d. OFFICE SYMBOL

e. SIGNATURE f. DUTY PHONE (DSN/Commercial)

h. EMAIL ADDRESS i. DATE SUBMITTED FOR APPROVAL

6. Point of Contact (Must be able to contact prior to departure and after arrival in case of delay(s) or cancellation(s).
a. NAME (Last, First Middle Initial) b. GRADE c. DUTY TITLE d. OFFICE SYMBOL

e. EMAIL ADDRESS f. DUTY PHONE (DSN/Commercial)

7. Weather Cancellation (Provide latest date/time for notification of mission cancellation by aircrew due to weather)
a. DATE b. TIME

DO NOT FILL OUT BELOW THIS LINE, FOR APPROVAL AUTHORITY ONLY
8. Approving Official
a. NAME (Last, First Middle Initial) b. GRADE c. DUTY TITLE d. OFFICE SYMBOL

e. SIGNATURE f. DUTY PHONE (DSN/Commercial) g. DATE

References: AR 95-1, dtd 14 March 2014, DOD4515.13-R, DODD 4500.56, NG Pam 95-5, Army Directive 2007-01.

Required Use includes those missions with a designated Required Use Traveler per DOD Directive 4500.56 and Army Directive 2007-01 where
the use of military aircraft is required due to continuous requirement for secure communications, security, or for responsive transportation to
satisfy exceptional scheduling requirements.

Operational Use includes those missions required to accomplish the Army's mission and to maintain the combat readiness of aviation and
ground units. Operational use missions include but are not limited to -
* Actual or simulated tactical and combat operations.
* Aircrew training.
* Intelligence.
* Counter-narcotics activities.
* Search and rescue.
* Transportation of prisoners.
*Flyovers for Command Purposes.
* Transport of troops/equipment.
* Special use (Humanitarian, Disaster Relief, and Deployments).
* Training orientation flights for LEAs, ROTC, JROTC, CAP, and Youth Challenge.
* Aeromedical evacuation by aeromedical units.

* Exercising command/supervision authority at adjacent and local installations.

Special Mission Use - unless specified, the ACOM, ASCC, DRU or NGB Commander owning the aircraft must approve of missions authorized in
this paragraph. They may delegate approval authority no lower than the first GO in the chain of command. Army aircraft may also be used for
the following purposes:
* Public Affairs to include but not limited to flyovers, tactical demos, aerial reviews, static displays, aerial activities.
* Orientation Flights for Media and Civic Leaders
* Evacuation or aeromedical evacuation by nonaeromedical units.
* Other Emergency Situations.

* Other - (Per Army Directive 2007-01 memorial services, retirements, graduations, public ceremonies, field demonstrations), military spouse
orientation flight, support community relations, Congress and staff IAW DOD4515.13-R.

Other Official Travel - administrative travel includes travel to give speeches; attend conferences, meetings or training courses; make routine
site visits; and other similar uses. All travel will comply with Army Directive 2007-01.

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