| TRIPLER ARMY MEDICAL CENTER (TAMC) |
| PERMANENT HOUSING QUESTIONAIRE |
| LAST NAME: _______________ FIRST NAME: ______________ MIDDLE INITIAL: __ |
| ( ) I will be an unaccompanied trainee. |
| ( ) I will have command sponsored family members living with me and will be requesting an exception to policy to live off-post. NOTE: An exception to policy letter must be sent to the TAMC Medical Education Office using the sample format located on this Web site. |
| ( ) I will have the following command sponsored family members living with me. |
| NAME | SEX | RELATIONSHIP | DATE OF BIRTH |
| ( ) If I have extenuating circumstances that require any specific type of post quarters (such as a single level because of an invalid spouse), these circumstances are noted below. |
| PERMANENT MAILING ADDRESS (Where you can always be reached): |
| Telephone number and / or e-mail address where I can be reached (from now until the time I leave for Hawaii): |
| Phone ( ) ______________________ |
| E-mail: ___________________________ |
| SIGNATURE: | DATE: |
| FAX this completed questionnaire to the Tripler Army medical Center Graduate Medical Education Office at (808) 433-1559. |