When completing this form, use the sample, “print neatly”, and read the guidance provided below before completing the applicable parts.
Page 1 (Part I, II, & III)-
PART I – GENERAL INFORMATION: If information requested in one box is the same as information in a prior box, put “See Item #__” listing the applicable item number. For Item #24 list the First, MI, and Last Name of next of kin and relationship (example: John H. Doe – Father) .
PART II – ACADEMIC INFORMATION: It is not necessary for us to know your graduation date (Item #29), credits towards degree (Item #32), and credits required for degree (Item #33) at this time so those items are “N/A” as indicated.
PART III – CURRENT OR PRIOR MILITARY SERVICE (TO INCLUDE OFFICER PRODUCTING PROGRAMS): If you have never been in the military “or” ROTC before, check the box top left that says “NOT APPLICABLE (GO TO PART IV)” and go to Part IV which starts on page 2. Otherwise, provide the required information before you go to page 2.
Page 2 (Part IV)-
PART IV – STUDENT STATEMENTS:
On the very top right of the form, print your Last Name and the last four of your SSN.
ITEM #42 (Release of Information) – Read the statement, and put an X in the box and your initials to the left of the box.
ITEM #43 (Statement of Criminal Proceedings by Civil or Military Authorities) – Read the statement carefully. If you have any questions ask the ROTC Admin Office. Put an X in the box that corresponds to your answer and your initials to the left of that box. IF you “X” and initial the box “The above statement is not true”, then to the right of the box you must explain why in the space provided.
ITEM #44 (Substance Abuse) – Read the three possible choices, and put an X in the box that corresponds to your answer and your initials to the left of the box. If you answer the second or third boxes indicating you have been a recent user or past user of illegal substances or drugs you must explain “When” and “How Often” in the spaces provided to the right of the box.
ITEM #45 (Religious Accommodation) – Read the statement, and put an X in the box and your initials to the left of the box.
ITEM #46 (Conscientious Objection) – Read the statement, and put an X in the “left” box to indicate you are not a conscientious objector (then put your initials to the left of the box). If you feel you might be a conscientious objector, do not check the “right” box (STOP and see your ROTC Admin Office immediately for clarification).
ITEM #47 (DOD Homosexual Conduct Policy Briefing) – Read the statement, then in the box “X” and put your initials just to the left of the box.
JUST BELOW ITEM 47, SIGN AND DATE TO THE RIGHT OF THE STATEMENT “All information given on this form is correct to the best of my knowledge”
ITEM #48 (Loyalty Oath – Optional for Non-Contracted Cadets) – You do not have to complete this item if you are not contracting with ROTC. However, you should read the loyalty oath and if you have no objection please sign and date where indicated. REMEMBER, signing the loyalty oath “does not” constitute a contractual agreement or obligation between you and ROTC (or the government).Download Form Sample Form