I'd Like to Know More About HSU/OBU ROTC
First Name MI Last Name Cell Phone E-mail School Address City State ZIP Phone Permanent Address City State ZIP Phone Birth Date 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YearPlace of Birth (City) (County) (State) Religious Preference Blood Type ACT Score SAT Score Sex M F Height Weight Marital Status M S Dependents Yes No #of Dependents Race African American American Indian Asian Caucasian Hispanic Other Citizenship: US US Born Naturalized Born Overseas w/ US Parents Dual Citizenship Non US Immigrant Alien Non-immigrant Alien Refugee Next of Kin: Name Address Phone College of Attendance Expected Graduation Date CGPA Major Minor ROTC Scholarship Recipient Y N Other Scholarships Credits Earned Toward Degree High School Attended Graduation Date GPA Have you been in JROTC? Y N # Years Are you currently in the Armed Forces: USAR ARNG US Army Navy USNR Marine Corps Marine Reserve Air Force Air Guard Coast Guard Coast Guard Reserve Unit: Prior Service: Have you ever been in an officer producing program? Y N Were you ever disenrolled from the ROTC Program? Y N Were you ever enrolled in a Service Academy? Y N Were you ever discharged from the Armed Forces? If Yes, what type of discharge? RE Code Months of Active Service: Have you ever been discharged for medical reasons? Y N If yes, expain