CUI // PRVCY — DEMONSTRATION ENVIRONMENT · NOTIONAL DATA ONLY

Reyes, Dana R.HM2

EDIPI1234567890

SexF

DOB1994-06-14

Age32

ServiceNavy

ComponentActive

Unit1MARDIV

PULHES111111

DeployabilityCategory 2

IMR: PMRDLMC 1Dental: FMRPHA: PMRImmunization: PMRLabs: NMRMedical Equipment: FMR

Member Forms / AF FORM 4446

← Member Forms

AF FORM 4446

Department of the Air Force Physical Fitness Assessment Scorecard

AF Form 4446 · 20221216 — Air Force PFA Scorecard

Fitness

Privacy Statement

AUTHORITY: Title 10 United States Code 9013, Secretary of the Air Force; DAFMAN 36-2905, Department of the Air Force Physical Fitness Program and Policy. PURPOSE: Information is used to positively identify an individual prior to administration of the Air Force Physical Fitness Assessment (PFA). ROUTINE USES: In addition to those disclosures generally permitted under 5 U.S.C. 552a(b) of the Privacy Act, these records or information contained therein may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 552a(b)(3); Blanket Routine Uses applies. DISCLOSURE: Failure to provide the requested information will result in non-administration of the Fitness Assessment.

PART I — Member Completes

Member identifying information. Fields are blank for demonstration (notional data).

Rank / Name

Unit

DoDID

Duty Phone

Gender

Age

Is this a Diagnostic PFA?

No. Official PFA Yes

If Diagnostic — Accept Diagnostic results below as Official PFA?

YES NO

PART II — Test Administrator Completes

Height, weight, key dates, and the fitness component scoring table.

Height (inches)

Weight (lbs)

FSQ Date

PFA Date

Component	AF FM 469 Exempt	Measurement	Min Value Met?
Strength
Push-up	Yes No	Reps:	Yes No
Hand-Release Push-up (HRPU)	Yes No	Reps:	Yes No
Endurance
Sit-up	Yes No	Reps:	Yes No
Cross-Leg Reverse Crunch (CLRC)	Yes No	Reps:	Yes No
Timed Forearm Plank	Yes No	Time:	Yes No
Cardio
1.5 Mile Run	Yes No	Time:	Yes No
20 Meter HAMR	Yes No	Shuttles:	Yes No
2 KM Walk	Yes No	Time:	Yes No

Did Not Finish (DNF)

Notes

Total Score

PART III — Acknowledgement

I acknowledge the above information reflects my performance. I may address issue IAW DAFMAN 36-2905 on removing PFA scores. NOTE: Refusal to sign does not invalidate the PFA.

Member Testing

Signature

Date

Test Administrator

Print Name

Signature

Date

I experienced an injury or illness during this PFA & will immediately pursue evaluation at a Medical Treatment Facility. I understand this PFA will count unless rendered invalid by the Unit/CC within 5 duty days (conclusion of next UTA for non-AGR ARC Airmen). If no request to invalidate this PFA is received by the FAC from my Unit/CC by the 6th duty day (conclusion of next UTA for non-AGR ARC), I understand this PFA will be entered in myFitness.

FAC / UFAC

Print Name

Signature

Date

*Note: FAC/UFAC will only sign above if member checks block indicating presence of illness or injury during test. FAC signature acknowledges the requirement to hold score for 5 duty days (myFitness input on 6th duty day). For non-AGR ARC member, FAC staff will hold scores until the next UTA and enter scores into myFitness upon conclusion of that UTA.

I have received and considered the provided medical documentation and render this test [ valid / invalid ] due to injury/illness.

Determination

Valid Invalid

Unit Commander

Print Name

Signature

Date

Paratus · AF FORM 4446 — Paratus-native form

AF FORM 4446 — Air Force Physical Fitness Assessment · build 2026-07-19 · Demonstration — notional data only