DA Form 591G Rotc Supplemental Service Agreement for Special Medical Program Participants

DA Form 591G or the "Rotc Supplemental Service Agreement For Special Medical Program Participants" is a Department of the Army-issued form used by and within the United States Military.

The form - often incorrectly referred to as the DD form 591G - was last revised on October 1, 1985. Download an up-to-date fillable DA Form 591G down below in PDF-format or look it up on the Army Publishing Directorate website.

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ROTC SUPPLEMENTAL SERVICE AGREEMENT FOR SPECIAL MEDICAL PROGRAM PARTICIPANTS
(TO ROTC CONTRACTS EXECUTED ON AND AFTER 1 JUN 84)
For use of this form, see AR 601-25; the proponent agency is the Office of the Deputy Chief of Staff for Personnel.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
50 USC App 456(d)(1), 10 USC 275.
PRINCIPAL PURPOSES:
Used as a supplement to DA Form 591 and to show agreement to accept commission as an officer in the U.S. Army
Reserve and participate in the USAR. It is also used to establish the obligation incurred by special medical program
officers.
ROUTINE USES:
Information is used to establish and record the obligation incurred by special medical program participants. The SSN is used
to identify the individual.
DISCLOSURE:
It is mandatory that special medical program participants complete DA Form 591g. Failure to complete this form will make
you ineligible for consideration for this delay.
This information should be carefully studied before acknowledging.
Sign all copies and attach one DA Form 591g to each copy of DA Form 591.
1. In consideration of my request for educational delay as a special medical program participant, I understand and agree to
comply with the following service requirements if my request is granted:
a. To faithfully pursue a full-time course of study leading to a degree in medicine, osteopathy, dentistry, veterinary
medicine, optometry, podiatry, psychology (doctorate), sanitary engineering, or social work.
b. To be considered a participant in the Medical Service Early Commissioning Program (AR 601-130).
c. If not assigned to Medical Services Corps, to be detailed thereto for control and accounting purposes.
d. If pursuing a degree in medicine, osteopathy, dentistry, or veterinary medicine, to accept appointment or reappointment
in the Medical, Dental, or Veterinary Corps upon graduation, if offered.
e. To enter on active duty within one (1) year of appointment or reappointment unless granted further delay by proper
authority.
f. Branch transfer to the Medical, Dental, or Veterinary Corps of the Reserve of the Army upon graduation does not bind
the United States Army to ordering a period of active duty. Entry on active duty will be contingent upon Army requirements
at the time active duty qualifications are determined.
2. Having studied the above service requirements, I hereby volunteer for entry on active duty when and if my services are
required. If I am excess to the needs of the Active Army, I will fulfill the remainder of my statutory obligation by serving
satisfactorily in the Ready Reserve. I agree to serve a period of active duty as indicated below.
a. If delayed to pursue a degree in medicine, osteopathy, dentistry, veterinary medicine, podiatry, or optometry, I will
serve on active duty for a period of three (3) consecutive years.
b. If delayed to pursue a degree in psychology, sanitary engineering, or social work, I will serve on active duty for a
period of four (4) consecutive years unless a lesser minimum obligation is in effect for my specialty at the time of entry on
active duty.
c. If I received Army scholarship assistance while participating in the ROTC program (10 USC 2107), I will serve on active
duty for a period of from 2 to 5 consecutive years as stipulated in my ROTC contract.
3. If I should withdraw from the course of study for which delay was approved or fail to qualify for branch transfer to the
Medical, Dental, or Veterinary Corps, I understand and agree to comply with the following active duty and Reserve
participation requirements. Service will be performed in the USAR branch in which originally appointed from ROTC,
unless otherwise directed by the Department of the Army.
DA FORM 591g, OCT 1985
APD LC v1.01ES
ROTC SUPPLEMENTAL SERVICE AGREEMENT FOR SPECIAL MEDICAL PROGRAM PARTICIPANTS
(TO ROTC CONTRACTS EXECUTED ON AND AFTER 1 JUN 84)
For use of this form, see AR 601-25; the proponent agency is the Office of the Deputy Chief of Staff for Personnel.
DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:
50 USC App 456(d)(1), 10 USC 275.
PRINCIPAL PURPOSES:
Used as a supplement to DA Form 591 and to show agreement to accept commission as an officer in the U.S. Army
Reserve and participate in the USAR. It is also used to establish the obligation incurred by special medical program
officers.
ROUTINE USES:
Information is used to establish and record the obligation incurred by special medical program participants. The SSN is used
to identify the individual.
DISCLOSURE:
It is mandatory that special medical program participants complete DA Form 591g. Failure to complete this form will make
you ineligible for consideration for this delay.
This information should be carefully studied before acknowledging.
Sign all copies and attach one DA Form 591g to each copy of DA Form 591.
1. In consideration of my request for educational delay as a special medical program participant, I understand and agree to
comply with the following service requirements if my request is granted:
a. To faithfully pursue a full-time course of study leading to a degree in medicine, osteopathy, dentistry, veterinary
medicine, optometry, podiatry, psychology (doctorate), sanitary engineering, or social work.
b. To be considered a participant in the Medical Service Early Commissioning Program (AR 601-130).
c. If not assigned to Medical Services Corps, to be detailed thereto for control and accounting purposes.
d. If pursuing a degree in medicine, osteopathy, dentistry, or veterinary medicine, to accept appointment or reappointment
in the Medical, Dental, or Veterinary Corps upon graduation, if offered.
e. To enter on active duty within one (1) year of appointment or reappointment unless granted further delay by proper
authority.
f. Branch transfer to the Medical, Dental, or Veterinary Corps of the Reserve of the Army upon graduation does not bind
the United States Army to ordering a period of active duty. Entry on active duty will be contingent upon Army requirements
at the time active duty qualifications are determined.
2. Having studied the above service requirements, I hereby volunteer for entry on active duty when and if my services are
required. If I am excess to the needs of the Active Army, I will fulfill the remainder of my statutory obligation by serving
satisfactorily in the Ready Reserve. I agree to serve a period of active duty as indicated below.
a. If delayed to pursue a degree in medicine, osteopathy, dentistry, veterinary medicine, podiatry, or optometry, I will
serve on active duty for a period of three (3) consecutive years.
b. If delayed to pursue a degree in psychology, sanitary engineering, or social work, I will serve on active duty for a
period of four (4) consecutive years unless a lesser minimum obligation is in effect for my specialty at the time of entry on
active duty.
c. If I received Army scholarship assistance while participating in the ROTC program (10 USC 2107), I will serve on active
duty for a period of from 2 to 5 consecutive years as stipulated in my ROTC contract.
3. If I should withdraw from the course of study for which delay was approved or fail to qualify for branch transfer to the
Medical, Dental, or Veterinary Corps, I understand and agree to comply with the following active duty and Reserve
participation requirements. Service will be performed in the USAR branch in which originally appointed from ROTC,
unless otherwise directed by the Department of the Army.
DA FORM 591g, OCT 1985
APD LC v1.01ES
3.
a.
Nonscholarship obligation, 2-to 4-year active obligation. A period of 8 years as a commissioned officer to
include not less than 2 nor more than 4 consecutive years of active duty. The required period of active duty will be based
on the needs of the Army when my delay ends. Upon release from active duty, I will serve the remainder of the 8-year period
in the Ready Reserve.
b.
year active duty obligation. A period of 8 years as a
Scholarship obligation (Enter 2 through 5 years)
commissioned officer to include a period of from 2 to 5 consecutive years of active duty based on receipt of Army
scholarship assistance while participating in the ROTC program (10 USC 2107). Upon release from active duty, I will serve
the remainder of the 8-year period in the Ready Reserve. (The 5-year active duty obligation is only required from those
individuals who received ROTC scholarship benefits for 5 years in order to complete their required undergraduate study.)
4. If I am not required to serve on active duty, I agree to serve on active duty for training for the period required to complete a
resident officer basic course as determined by the Department of the Army, and subject to further orders of the Secretary of
the Army. Upon release from active duty for training, I will serve satisfactorily in the Ready Reserve until the 8th anniversary
date of my original appointment, unless sooner discharged by proper authority.
5. I agree and consent to the terms of this agreement and understand that I will not be authorized to resign my commission
until the required service is completed.
NAME (Typed or Printed)
SOCIAL SECURITY NUMBER
SIGNATURE
DATE SIGNED
DA FORM 591g, OCT 1985
2
APD LC v1.01ES

Download DA Form 591G Rotc Supplemental Service Agreement for Special Medical Program Participants

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