You do not have to answer any of the questions that follow.  However, we have carefully designed them to help us present you with the most beneficial information for your unique circumstance. 

***This form is protected by the Privacy Act

***This form will be used for Official use only 

***We Respect Your Privacy and will NEVER give out your e-mail or personal contact information.

   General Information

1)	Today’s date:
2)	First name:
3)	Last name:
4)	Current age:
5)	US Citizen (Yes or No):
6)	E-mail address:
7)	Phone number:
8)	Mailing address:

High School Information (This information helps us determine whether you are a good candidate for a full scholarship)

1)	High school name:
2)	High school city and state:
3)	High school graduation month and year:
4)	High school GPA (un-weighted):
5)	SAT score (if applicable):
6)	ACT score (if applicable):
7)	Sports you played in high school:
8)	Extracurricular activities you participated in during high school:
9)	Years of Junior ROTC (JROTC) credit (if applicable):

College Information (if applicable)

1)	Admitted to Auburn (Yes or No):
2)	College credits earned to date (indicate semester or quarter):
3)	Current course load:
4)	Cumulative college GPA:
5)	Academic major:
6)	Extracurricular activities you participate in at college:

Prior Service Info (if applicable)

1)	Branch of Service:
2)	Highest rank held:
3)	Date of enlistment:
4)	Date of discharge (if applicable):
5)	Type of discharge (if applicable):
6)	Current National Guard / Reserve Unit (if applicable):

Eligibility Information (Your responses to these questions help us determine if you are eligible to contract into Army ROTC.  Please answer the questions candidly.  We may be able to get a waiver for you if you have to give us an answer that you think will disqualify you.)

1)	Known Allergies:
2)	Significant medical issues:
3)	Have you ever filed for bankruptcy?
4)	Have you ever been convicted, fined, imprisoned, placed on parole or pardoned for anything other than traffic violations under $250, to include:
a.	Being arrested for DUI or underage drinking?
b.	Having a criminal charge expunged from your record?
c.	Being charged with a crime as a juvenile?
d.	Being assigned to a pre-trial diversion program?
5)	Do you have any charges now pending against you in any court?

** Additional Comments: What made you interested in ROTC? Would you like to know more about Scholarship opportunities? Would you like to learn about the Simultaneous Membership Program (SMP) with the National Guard or Reserve?

Answer: