(Office Symbol)                                                         (Date)

MEMORANDUM FOR (Appropriate Agency– Appendix B)

SUBJECT:  Evaluation Report Appeal (Appellant’s Name, Rank, SSN, Report Period Covered)

1.  Under the provisions of AR 623-3 Evaluation Reporting System, I appeal the subject evaluation report.  (Include pending personnel actions and appeal processing priority.)

2.  This appeal is based solely on administrative error.  (Identify each portion of the report with which you disagree.  State each entry as it appears and as it correctly should appear.)

3.  (Include certified true copies of related documents to support your request, for example, rating schemes in effect throughout the entire rating period, orders, leave and earnings statements, APFT scorecard (DA Form 705) or other valid documents to verity correction of error.  Original statements from knowledgeable individuals also may be included to support your request.)

4.  (Be sure to include a telephone number, preferably DSN, at which you may be reached.  Notify the addressee promptly if your address changes.)

Encl                                                               (Signature block with mailing address,

1.  Copy of evaluation report                          if other than address on letterhead)

2.  (Number and list enclosures

of appropriate evidence)