The Coast Guard memorandum header image carries the unit name, address, staff symbol, phone and email. Enter the unit name here.
Coast Guard Special Request Memorandum
A request to your command (special liberty, early departure, uniform or grooming waiver, school, TAD, reenlistment location) laid out in the Coast Guard Correspondence Manual's memorandum format, with Thru routing and endorsement blocks.
What this worksheet covers
Name, rank, and unit prefill from your service profile.
Form details
- Unit name (letterhead)
- Unit address, staff symbol, phone
- SSIC
The Standard Subject Identification Code for the subject (look it up in the SSIC list in the Directives Library). Leave and liberty requests commonly use 1050; confirm with your admin.
- Date
Placed below the SSIC, dd Mmm yyyy (for example 24 Sep 2026). It is the date the final signer signs.
- To
On a Coast Guard memo this line prints as "To:". Address the commanding officer or officer in charge. (This sheet's renderer labels the line "MEMORANDUM FOR" and places it before From; the Coast Guard order is From, To, Thru, Subj.)
- Thru (numbered routing order)
List every link in the chain that must see the request, numbered in routing order, starting with your immediate supervisor. Each may approve by signing or initialing and dating beside the Thru line.
- From
Your name and rate. You sign on the From line (above your typed name). If someone signs for you, they write "for" to the left of the signature.
- Subj
All capitals, about 10 words or fewer. Repeat it on every page.
- Request
State exactly what you are asking for, with dates and times.
- Justification
- Impact on the unit / coverage
- Contact while away
- Decision block (Approve / Disapprove / Other)
Typed two lines below the last paragraph and before the closing #, for the decision authority (the CO or OINC) to initial.
- Type of request
Worksheet aid: what kind of request this is. It does not print on the memo.
- Requested start
Worksheet aid: start date of what you are requesting.
- Requested end
Worksheet aid: end date.
- Enclosure(s)
Listed two lines below the # symbol, in order of mention.
- Endorsements (FIRST ENDORSEMENT, SECOND ENDORSEMENT …): From / To / recommendation / signature and date
Each Thru addressee forwards the memo, on the same page if it fits. A routine endorsement is "Forwarded, recommending approval." A disapproval recommendation is significant and gets copied to prior endorsers.
Draft / worksheet aid. Prepare it here, then transcribe into Routed as a memorandum through your chain of command (supervisor, department head, XO/XPO) to the commanding officer or officer in charge. Leave itself is then entered in Direct Access.. This is not an official submission. Check it against the current official Memorandum (COMDTINST 5216.4E) before use.
How to fill out the Memorandum (COMDTINST 5216.4E)
The Coast Guard has no servicewide "special request chit" form. Requests to the command go as a standard Coast Guard memorandum routed Thru the chain of command, each of whom forwards it with a recommendation (an endorsement). Some units keep a local request chit; if yours does, use it and copy the paragraphs from here. When: Any time you need the command's approval for something outside routine: special liberty, a regular-leave exception, a uniform or grooming accommodation, a school or TAD request, a reenlistment ceremony location, or a humanitarian request. Submit early enough for every Thru addressee to act.
Step by step
- Header: the unit letterhead, the SSIC and date at the right, then MEMORANDUM.
- From: your name and rate (you sign above the From line). To: the commanding officer or officer in charge. Thru: your supervisor, department head, and XO/XPO, numbered in routing order.
- Subj: a short subject in capitals, about 10 words or fewer.
- Paragraph 1 states exactly what you request, with dates. Paragraph 2 justifies it. Paragraph 3 covers impact on the unit (who covers your duties). Paragraph 4 gives your contact information.
- End with the # symbol, then any enclosures. Each Thru addressee endorses (forwarded, recommending approval or disapproval) and signs.
What a strong one looks like
- Ask for one thing per memo, with exact dates and times.
- Show you've solved the coverage problem: name the qualified member who will stand your watch or take your duties.
- Number paragraphs (required when there is more than one) and keep subparagraphs as a., b.; never mix numbering and bullets at the same level.
- Use a decision block (Approve / Disapprove / Other) when the CO will decide on the memo itself.
Common mistakes
- Skipping a Thru addressee. It comes back to you and costs days.
- A vague request ("some time off in October").
- More than two pen-and-ink corrections on internal correspondence.
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