MY IMPORTANT RETIREMENT DATES

TAP CLASS:

(2 YEARS OUT) DATE: __________________ LOCATION: _____________________________________________

(1 YEAR OUT)

PRE-SEP BRIEF:

DATE: __________________ LOCATION: _____________________________________________

DATE: __________________________ LOCATION: _____________________________________________

FLEET RESERVE REQUEST MESSAGE: DATE TIME GROUP OF: RECEIVED MESSAGE (2-5 DAYS): __________________________
PROCESSING MESSAGE (2-4 WEEKS): _______________________
APPROVAL MESSAGE (90 DAYS PRIOR): _____________________
PSD APPOINTMENT:

DATE: _________________ TIME: ________________

MEDICAL APPOINTMENT:

DATE: _________________ TIME: ________________

DENTAL APPOINTMENT:

DATE: _________________ TIME: ________________

STATEMENT OF UNDERSTANDING
RETIREE:
BY SIGNING BELOW, INDICATES THAT I UNDERSTAND I MUST STAY IN CONSTANT COMMUNICATION WITH MY CEREMONY
SPONSOR AND COMMAND CAREER COUNSELOR AT ALL TIMES. I WILL BE HELD ACCOUNTABLE ALONG WITH MY SPONSOR FOR
ALL ASPECTS OF THE RETIREMENT CEREMONY AND ITS PROCESSES. I WILL PROVIDE ALL REQUIRED INFORMATION,
UPDATES AND ITEMS REQUIRED IN A TIMELY MANNER. ANY CHANGES WILL BE PROMPTLY ADDRESSED. I AM AWARE THAT I
AM RESPONSIBLE FOR THE NOTIFICATION OF ALL CEREMONY PARTICIPANTS SUCH AS PRESIDING OFFICAL, MASTER OF
CEREMONIES, SIDE BOYS, ETC. I AM ALSO AWARE THAT I AM RESPONSIBLE FOR THE COST OF INVITATIONS, PROGRAMS,
FLOWERS, PRESENTED ITEMS, SHADOW BOX, CEREMONY REFRESHMENTS, RECEPTION, ETC.
SIGNED: ____________________________________________________________________ DATE: _______________________
CEREMONY SPONSOR (COORDINATOR):
BY SIGNING BELOW, INDICATES THAT I UNDERSTAND I HAVE BEEN ASKED TO BE THE SPONSOR/COORDINATOR FOR THE
RETIREMENT CEREMONY. I WILL BE THE COMMAND POINT OF CONTACT FOR ALL ISSUES RELATED TO THE RETIREMENT
CEREMONY AND BE HELD ACCOUNTIBLE FOR ALL ASPECTS OF THE CEREMONY AND ITS PROCESSES. I UNDERSTAND I MUST
STAY IN CONSTANT COMMUNICATION WITH THE RETIREE AND COMMAND CAREER COUNSELOR AT ALL TIMES.
MY
RESPONSIBILITIES ARE TO ASSIST THE RETIREE AND COMMAND WITH MOST ASPECTS OF THE RETIREMENT CEREMONY IN
ACCORDANCE WITH REFERENCES (1) MILPERSMAN 1800-010 THROUGH 1800-070, (2) SECNAVINST 1811.3M, (3)
BUPERSINST 1001.39D CHAPTER 20, (4) CCC RETIREMENT GUIDE. MY RESPONSIBILITIES INCLUDE CAN BE FOUND ON THE
RESPONSIBILITY GUIDE WHICH INCLUDE, BUT NOT LIMITED TO, ASSISTING THE RETIREE WITH: INVITATIONS, PROGRAMS,
SCRIPT, TIMELINESS OF INFORMATION, QUIET HOURS REQUEST, CEREMONY SET UP AND CLEAN UP, WORKING PARTY,
PARKING, ETC. IF I HAVE ANY QUESTIONS ABOUT THE PROCESS I WILL NOT HESITATE TO ASK THE COMMAND CAREER
COUNSELOR.
SIGNED: ____________________________________________________________________ DATE: _______________________
SHADOW BOX COORDINATOR:
BY SIGNING BELOW, INDICATES
RESPONSIBLE FOR OBTAINING A
CONTENTS, AND FLAG MOUNTED)
PROVIDE ME WITH THE COMMAND

THAT I UNDERSTAND MY RESPONSIBILITIES IN REGARDS TO THE SHADOW BOX. I AM

SHADOW BOX AND HAVING IT PRESENTABLE (COMMAND HISTORY ENGRAVED PLAQUE,
NO LATER THAN 10 WORKING DAYS PRIOR TO THE RETIREMENT DATE. THE RETIREE WILL
HISTORY LIST, RIBBONS, AND MEDALS.

SIGNED: ____________________________________________________________________ DATE: _______________________

COMMAND CAREER COUNSELOR: (TO BE COMPLETED WHEN ALL THE ABOVE ARE SIGNED)(CANNOT BE ASSIGNED AS A CEREMONY
OR SHADOW BOX COORDINATOR)
BY SIGNING BELOW, INDICATES THAT I AM AWARE OF YOUR DESIRE TO TRANSFER TO THE FLEET RESERVE AND THAT I AM
AWARE OF THE SELECTION OF YOUR CEREMONY SPONSOR/COORDINATOR AND SHADOW BOX COORDINATOR.
SIGNED: ____________________________________________________________________ DATE: _______________________

RETIREMENT INFORMATION GUIDE

(PLEASE PROVIDE FULL NAME, RATE, RANK, WARFARE, AND/OR DESIGNATOR FOR ALL NAMES)
INITIAL DATA
NAME (LAST, FIRST MIDDLE):________________________________________________________________________________
RATE (SPELLED OUT): ________________________________________________ WARFARE/DESIGNATION:_________________
PHONE NUMBERS: HOME: ______________________ CELL: _________________________ WORK: ________________________
EMAIL ADDRESS: WORK: _____________________________________ HOME: _________________________________________
EAOS/EOS: _____________ PRD: _____________ ADSD: ____________
TOTAL YEARS OF SERVICE AT RETIREMENT: ________ YEARS ________ MONTHS
LAST DAY AT THE COMMAND (BEFORE STARTING TERMINAL LEAVE): ____________ ACTUAL RETIRMENT DATE: ____________

CEREMONY DATA
CEREMONY (CIRCLE ONE):

FULL HONORS

SMALL CEREMONY

RECEPTION ONLY

NO CEREMONY

CEREMONY SPONSOR (COORDINATOR): __________________________________________________________________________

PHONE NUMBERS: HOME: ______________________ CELL: ________________________ WORK: _________________________
EMAIL ADDRESS: WORK: _____________________________________ HOME: _________________________________________
CEREMONY (CIRCLE ONE):

DURING

DRILL WEEKEND

DURING THE WEEK

CEREMONY DATE: ______________ TIME: _________ CEREMONY LOCATION: _________________________________________

APPROXIMATE NUMBER OF GUESTS ATTENDING CEREMONY: _________________
REHEARSAL #1 DATE: ______________ TIME: ____________
(2-3 DAYS PRIOR)
CHOOSE ONE OR BOTH:

REHEARSAL #2 DATE: _____________ TIME: _____________

(SAME AS CEREMONY) (3-4 HOURS PRIOR)

CAKE AND REFRESHMENTS IMMEDIATELY AFTER CEREMONY

FULL RECEPTION: OPEN TO ALL

FULL RECEPTION AT OTHER LOCATION

INVITATION ONLY

RECEPTION DATE: _____________ TIME: _________ RECEPTION LOCATION: ________________________________________

APPROXIMATE NUMBER OF GUESTS ATTENDING RECEPTION: ___________________
UNIFORM: OFFICIAL PARTY: ________________________________________________ (CIRCLE ONE): MEDALS

RIBBONS

SIDEBOYS: ______________________________________________________ (CIRCLE ONE): MEDALS

RIBBONS

MILITARY GUESTS: _______________________________________________ (CIRCLE ONE): MEDALS

RIBBONS

CIVILIAN GUESTS: _______________________________________________

MASTER OF CEREMONIES (READS SCRIPT): _____________________________________________________________________
NATIONAL ANTHEM SUNG BY: _________________________________________________________________ / OR MUSIC ONLY
INVOCATION/BENEDICTION: _______________________________________________________________ / OR BASE CHAPLAIN
GUEST SPEAKER (TALKS ABOUT YOU, YOUR CAREER): ____________________________________________________________
PRESIDING OFFICIAL (PRESENTS AWARDS TO YOU): _____________________________________________________________
BOATSWAINS MATE: _______________________________________________________________ / OR PROVIDED BY THE BASE
ESCORT FOR SPOUSE: _______________________________________________________________________________________
ESCORT FOR ADDITIONAL FAMILY MEMBERS (IF NEEDED): ________________________________________________________
MUSIC NEEDED FOR CEREMONY (CIRCLE CHOICES):
GOD BLESS THE USA

NATIONAL ANTHEM

RUFFLES AND FLOURISHES

NAVY HYMN

MIX OF PATRIOTIC MUSIC

ANCHORS AWEIGH

OTHER: ___________________________________________________________________________________________
OTHER: ___________________________________________________________________________________________

FIRST, MIDDLE INITIAL, LAST NAME

RATE/RANK

WARFARE/DESIGNATION

SIDE BOYS #1 ______________________________________________

_____________________

____________________

#2 ______________________________________________

_____________________

____________________

#3 ______________________________________________

_____________________

____________________

#4 ______________________________________________

_____________________

____________________

#5 ______________________________________________

_____________________

____________________

#6 ______________________________________________

_____________________

____________________

STAND BY ______________________________________________

_____________________

____________________

PRESENTATION INFORMATION
DO YOU WANT LETTERS OF APPRECIATION PRESENTED TO YOUR FAMILY: YES

NO

SPOUSE (FIRST NAME, MIDDLE INITIAL, LAST NAME): __________________________________________________________

CHILDRENS (FIRST NAME, MIDDLE INITIAL, LAST NAME): #1 ____________________________________________________
#2 _______________________________________________ #3 ____________________________________________________
#4 _______________________________________________ #5 ____________________________________________________
PARENTS (FIRST NAME, MIDDLE INITIAL, LAST NAME): _________________________________________________________
_________________________________________________________
DO YOU WANT ANY OF THE FOLLOWING PRESENTED TO YOUR FAMILY? ALL COSTS ARE THE RESPONSIBILITY OF RETIREE(*).
FLOWERS FOR SPOUSE:

YES*

FLOWERS FOR CHILDREN: YES*

NO

FLOWERS FOR PARENTS: YES*

/
/

BALL CAPS FOR CHILDREN: YES*

IF YES, WHAT KIND: _______________________________________

NO

IF YES, WHAT KIND: _______________________________________

NO
/

IF YES, WHAT KIND: _______________________________________

NO

IF YES, HOW MANY: ______________

FLOWERS AND/OR BALLCAPS WILL BE PRESENTED TO MY FAMILY BY: ______________________________________ / MYSELF

SPOUSE MEDAL AND NECKLACE: YES*

NO

FOUND AT WWW.NAVYWIVES.COM

DO YOU WANT A LETTER FROM YOUR HOME STATE GOVERNOR: YES

/ NO

CPOS ONLY: DO YOU WANT A LETTER FROM THE MCPON: YES

NO

DO YOU WANT A BOATSWAIN LANYARD AND PIPE PRESENTED: YES*

IF YES, WHAT STATE: ______________________

NO

SHADOW BOX WILL BE PRESENTED BY: _________________________________________________________________________

YOUR SHADOW BOX FLAG IS PROVIDED BY THE COMMAND, WHERE WOULD YOU LIKE YOUR FLAG FLOWN?
THE COMMAND CAN ONLY PAY POSTAGE FOR UP TO THREE LOCATIONS (FLAG PASSING FLAG IS COUNTED AS ONE LOCATION)
(FLAGS FLOWN ON STATION OR ON LOCAL SQUADRON AIRCRAFT WILL NOT COUNT TOWARDS YOUR TOTAL)(IF RETURN
SHIPPING AND HANDLING IS REQUIRED IT MUST BE PAID BY THE RETIREE)
FLAG LOCATION #1: ________________________________________________________________________________________
FLAG LOCATION #2: ________________________________________________________________________________________
FLAG LOCATION #3: ________________________________________________________________________________________
DO YOU WANT A FLAG PASSING CEREMONY: YES

NO

(YOU MUST PROVIDE A SEPARATE FLAG FOR THIS CEREMONY.)

WHERE WOULD YOU LIKE THIS FLAG FLOWN: ____________________________________________________________________

WHO WILL YOU PRESENT YOUR FLAG TO: _________________________________________________________ / KEEP MYSELF

FLAG PASSING PARTICIPANTS IN ORDER FROM START TO FINISH (DOES NOT NEED TO BE ACCOURDING TO PAYGRADE):
FIRST, MIDDLE INITIAL, LAST NAME

RATE/RANK

WARFARE/DESIGNATION

#1 ______________________________________________

_____________________

____________________

#2 ______________________________________________

_____________________

____________________

#3 ______________________________________________

_____________________

____________________

#4 ______________________________________________

_____________________

____________________

#5 ______________________________________________

_____________________

____________________

#6 ______________________________________________

_____________________

____________________

STAND BY ______________________________________________

_____________________

____________________

UNIFORM FOR FLAG PASSING PARTICIPANTS: ________________________________________________ RIBBONS

MEDALS

HISTORY AND AWARDS

PROVIDE A COMPLETE COMMAND HISTORY WITH DATES.
YOUR SHADOW BOX.
DATE

TO

DATE

THIS WILL BE USED TO ENGRAVE YOUR PLAQUE THAT GOES INSIDE

COMMAND

____________

______________

______________________________________________________________(BOOT CAMP)

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

____________

______________

_________________________________________________________________________

ON A SEPARATE PIECE OF PAPER, WRITE YOUR BIOGRAPHY OF YOUR MILITARY CAREER. YOU MUST PROVIDE THIS
BIOGRAPHY TO YOUR GUEST SPEAKER, CHAPLAIN, CEREMONY COORDINATOR, AND COMMAND CAREER COUNSELOR NO LATER
THAN 30 DAYS PRIOR TO YOUR CEREMONY DATE. PLEASE INCLUDE ANY OR ALL OF THE FOLLOWING IN YOUR BIOGRAPHY:
-MILITARY OCCUPATION
-CHILDREN / GRANDCHILDREN
-OTHER AREAS TO DISCUSS

-MILITARY ACCOMPLISHMENTS
-PLACES YOU VISITED
-GREATEST TIMES IN THE NAVY
-INTENTIONS AFTER RETIREMENT
-MARITAL STATUS. WHEN, HOW LONG, TO WHOM.

ON THE ATTACHED AWARDS CHECKLIST PAGE, MARK WHICH AWARDS YOU HAVE AND WRITE OUT NEXT TO THEM HOW MANY YOU
WERE AWARDED AND WHAT KIND OF DEVICES ARE ATTACHED TO EACH AWARD.

INVITATIONS, PROGRAMS, SHADOW BOX INSTRUCTIONS

DO YOU WANT INVITATIONS: YES

NO

(POSTAGE IS PAID BY THE RETIREE)

WHO DO YOU WANT TO HANDLE THE INVITATIONS:

YOURSELF

CEREMONY SPONSOR

COMMAND

IF CEREMONY SPONSOR / COMMAND, ENSURE ADDRESS LIST IS PROVIDED NO LATER THAN 60 DAYS PRIOR TO CEREMONY
DATE. LIST ANY SPECIAL INSTRUCTIONS FOR YOUR INVITATIONS:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________

DO YOU WANT A CEREMONY PROGRAM: YES

NO

IF YES, PLEASE PROVIDE YOUR SPONSOR WITH PICTURES ON DISK NO LATER THAN 60 DAYS PRIOR TO CEREMONY.
50 PROGRAMS ARE PRINTED ON PLAIN WHITE PAPER UNLESS THE RETIREE PROVIDES SPECIAL PAPER.
LIST ANY SPECIAL INSRUCTIONS FOR YOUR PROGRAMS (SAMPLES ARE IN THE CCCS OFFICE): ________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
DO YOU WANT A SHADOW BOX: YES

NO

IF YES:

MEDALS

RIBBONS

MOUNTED INSIDE OF SHADOW BOX.

FUNDING FOR SHADOW BOX: OFFICERS WARDROOM, CHIEFS CPOA, E-6 FCPOA, E-5 MWR PAYS HALF ($50)
FUNDING FOR CONTENTS AND ENGRAVING PLAQUE: RETIREE, UNLESS OTHERWISE PROVIDED BY THE ASSOCIATION
INSTRUCTIONS FOR SHADOW BOX DESIGN:

STANDARD SHADOW BOX (3 COMPARTMENTS AND FLAG)

PLEASE DESCRIBE IF DIFFERENT DESIGN AND DRAW OUT ON SEPARATE PAPER AND KEEP IN THIS FOLDER:
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
INSTRUCTIONS FOR THE LAY OUT OF CONTENTS IN THE SHADOW BOX: ______________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
USE SPACE BELOW TO DRAW THE LAY OUT DETAILS (PLACEMENT OF RIBBONS/MEDALS, WINGS, RANK INSIGNIA, ETC):

STANDARD BOX:

DO YOU WANT DOG TAGS DRAPPED

OVER YOUR FLAG IN YOUR SHADOW
BOX? (IF YES, YOU MUST PROVIDE
THE TAGS.)
YES

NO

(USUALLY MEDALS/RIBBONS/WINGS)

(USUALLY HISTORY OF ASSIGNMENTS PLAQUE)

(MISC ITEMS OF IMPORTANCE TO RETIREE)