The document is a memorandum from a soldier in the 710th Area Support Medical Company of the Illinois Army National Guard requesting approval for a split assembly from a scheduled Unit Training Assembly or Multiple Unit Training Assembly. It includes spaces for the soldier to provide their rank, name, dates of the scheduled and requested split assemblies. It also includes lines for the platoon sergeant, platoon leader, and unit commander to approve or disapprove the request, as well as spaces for the soldier to provide a reason for the split and for the request to be verified once completed.

1. ILLINOIS ARMY NATIONAL GUARD
TH
710 AREA SUPPORT MEDICAL COMPANY
8660 W CERMAK ROAD
NORTH RIVERSIDE, IL 60546
MEMORANDUM FOR: COMMANDER, 710TH ASMC
SUBJECT: REQUEST FOR SPLIT ASSEMBLY
Rank and Name:
Date of UTA/MUTA:
Requested date of Split Assembly:
Split Assembly approved by Platoon Sergeant (initial): YES NO
Split Assembly approved by Platoon Leader (initial): YES NO
Split Assembly approved by Unit Commander (initial): YES NO
Signature of Requesting Soldier
(typed signature valid only if sent electronically)
Reason for Split:
Date actual Split accomplished:
Verified by:
Printed Name Signature
Date Verified: