SEE PRIVACY ACT STATEMENT IN AR 623-3

RATED SOLDIER’S NAME (Last, First, Middle Initial) SSN (FULL) PMOS DATE UIC / UNIT NAME

c. CHARACTER: (Include bullet commentsaddressing Rated Soldier’s performance asit relates to adherence to Army Values,Empathy, Warrior Ethos/Service Ethos, andDiscipline. Fully supports SHARP, EO, andEEO.)

d. INTELLECT: (Mental agility, Soundjudgment, Innovation, Interpersonaltact, Expertise)

e. LEADS: (Leads others, Builds trust,Extends influence beyond the chain ofcommand, Leads by example,Communicates)

f. ACHIEVES: (Gets results)

GA ARNG Form 2166-3-R-E, 2 MAY 2020 GA-G1-E

SOLDIER IS AVAILABLE NOT AVAILABLE* FOR SIGNATURE.

ALL PREVIOUS EDITIONS ARE OBSOLETE

RATER OVERALL PERFORMANCECOMMENTS: (BULLET FORMAT)

PART IV SENIOR RATER OVERALL POTENTIALb. COMMENTS: (NARRATIVE FORMAT)

*Memorandum for Record required for Soldiers not available for signature. Readiness NCO or S1 must sign on behalf of the Soldier.

COMMENTS:

(Comments required “Failed” APFT, “No” APFT, or “Profile” when it precludes performance of duty, and “No” for Army Weight Standards.)

PART III PERFORMANCE EVALUATION, PROFESSIONALISM, ATTRIBUTES, AND COMPETENCIES (Rater)COMMENTS:

COMMENTS:

COMMENTS:

E4 WORD PICTUREPART I ADMINISTRATIVE DATA

PART II APFT AND ARMY WEIGHT STANDARDSa. APFT Pass/Fail/Profile: Date: b. Height: Weight: Within Standard?

MOST QUALIFIED

HIGHLY QUALIFIED

QUALIFIED

NOT QUALIFIED

a. Select one boxrepresenting RatedSoldier's Overall potential.

MET STANDARD

MET STANDARD

MET STANDARD

MET STANDARD

DID NOT MEET

STANDARD

DID NOT MEET

STANDARD

DID NOT MEET STANDARD

DID NOT MEET STANDARD

/

________________________________________ Printed Name/Signature Sr. Rater (1SG)

_________________________________________ Printed Name/Signature Rater

__________________________________________ Printed Name/Signature Rated Soldier

Figure 3-1