If you are interested in finding out more information or are interested in Army ROTC fill in the following information. It is not necessary to fill in all the blanks, but the more information you provide us, the better we will be able to help you with your goals. Please be sure to leave an e-mail address, this is the fastest way we can contact you.
Personal Information First Name: Last Name:
Address Line 1: Address Line 2: City: , State: Zip: E-mail:
Local Phone: Home Phone: Cell Phone: Age: Sex: Male Female
US Citizen: Yes No Married: Yes No
College Information
Are You Presently Attending College? Yes No If yes, please answer the following questions College You Are Attending: Graduation Year: Academic Major : Minor(s): Cumulative GPA: GPA Last Semester:
Military Information Prior Service: Yes No Are you currently in NG/Reserves? Yes No
I am most interested in... The Army ROTC Program Army ROTC Scholarships Army ROTC Officer Careers Simultaneous Membership Program Active Duty NG/Reserves Nurse Athletics Questions and Comments: